Job Description

The Patient Financial Services Denial Specialist is responsible for reviewing denied claims and carrying out the appeals process. This position works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence, and possibly setting up arbitration between parties. The denial analyst has a working knowledge of state/federal laws that relate to contacts and to the appeals process. Maintains and monitors integrity of the claim development and submission process.

Essential Job Functions

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to and/or resolving appeals with third-party payers in a timely manner. Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Works closely with insurance and managed care companies to ensure proper review and processing of denied claims
• Acts as a liaison between insurance companies and physicians to provide medical necessity for denied claims
• Identifies and tracks payer denials trends and works with the payers to correct any erroneous denials and works with the departments to review and improve processes to avoid these denials in the future
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Contacts patients to communicate insurance coverage denials and works with the patient to overturn the denials related to patient information needed
• Works closely with Denial Manager to provide key information for the Denial Task Force Meetings. Complies with State and Federal regulations, accreditation/compliance requirements, and policies, including those regarding fraud and abuse, confidentiality, and HIPAA. Maintains current knowledge of rules and regulations of third party payers. Performs related duties as required

Training:

Candidate needs to be able to come onsite to either Burr Ridge or our Harvey location for a few weeks for training. They will then be able to work from home.

Required Qualifications

• High School Diploma or GED
• 3–5 years of Hospital Billing (HB) Denials experience
• Proven appeals and denial resolution experience
• Strong understanding of the revenue cycle from start to finish

Schedule:

M-F 7am-3:30pm

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