Denials Management Specialist

Edward Elmhurst Health; Arlington Heights (IL); On-site; USD 27,552 - 45,460; Full time

Benefits offered by this job

Premium pay: shift/on-call/holiday

Tuition Reimbursement

Free Parking

Wellness Program Savings Plan

Health Savings Account Options

Retirement Options with Company Match

Paid Time Off and Holidays

Community Involvement Opportunities

Job summary

Edward-Elmhurst Health in Arlington Heights, IL seeks a Denial Management Specialist to review and resolve denied patient insurance claims within standard business hours. The role collaborates across departments to determine denial causes and streamline the appeal process, communicating with payers and patients as needed.

Responsibilities include preparing appeals with necessary medical records and supporting documents, following up after appeals, and contributing to process improvements to

Qualifications

• Extensive computer knowledge and experience.
• Knowledge of standard billing guidelines, CPT/ICD9 coding, usual and customary (U&C) schedules.

Responsibilities

• Review and resolve denied patient insurance claims.
• Collaborate with internal departments to determine the denial and appeal process.
• Contact insurance companies or patients to gather information for the appeal.
• Submit appeals with corrected claims, medical records, and appeal letters.

Skills

Computer skills

Billing guidelines

CPT/ICD9 coding

U&C schedules

Education

High School Diploma

Job description

## Denials Management SpecialistApplylocations: NCO 3040 Salt Creek Ln Arlington Heightstime type: Full timeposted on: Posted Todayjob requisition id: R44781**Hourly Pay Range:**$22.14 - $33.21 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.**Position Highlights:*** Position: Denial Management Specialist* Location: Arlington Heights, IL* Full Time/Part Time: Full Time* Hours: Monday-Friday, standard business hours**A Brief Overview:** Reviews claim denials which pertain to medical necessity, pre-certification, authorization, and level of care requirements. This involves interaction with Physician Practices, Providers and Payers. **What you will do:*** Reviews and resolves denied patient insurance claims.* Works closely with internal departments in determining accurate denial and process for appeal. Contacts insurance companies/payer or patients to gather information necessary to complete the appeal process.* Sends appeals to insurance companies regarding denials by resubmitting corrected claim, submitting medical records and writing appeals letters in a timely manner* Provides process improvement recommendations to Supervisor to decrease future denials.* Utilizes software tools to identify denial, trends and payer issues. Shares findings with stakeholders.* Follows up on pending claim denials after appeal has been processed -by the insurance company.* Collaborates in the collection of data and sends monthly “Managed Care Denial Report” to appropriate department Leaders including: Physician Coding Manager; Physician Billing Manager and Director, VP of EEH Physician Practices and Vice President of EEH Revenue Cycle.* Maintains positive working relationships both externally and internally.**What you will need:*** **Education:** High School Required* **Experience:** 2 Years previous patient billing Or 2 Years managed care experience* **Skills:** Extensive computer knowledge and experience. Knowledge of standard billing guidelines, CPT/ICD9 coding, usual and customary (U& C) schedules**Benefits (For full time or part time positions):*** Premium pay such as shift, on call, holiday and more based on an employee’s job (For eligible positions)* Incentive pay for select positions* Opportunity for annual increases based on performance* Career Pathways to Promote Professional Growth and Development* Various Medical, Dental, Pet and Vision options* Tuition Reimbursement* Free Parking* Wellness Program Savings Plan* Health Savings Account Options* Retirement Options with Company Match* Paid Time Off and Holiday Pay* Community Involvement OpportunitiesEndeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals – Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) – all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.