Denials Management Specialist

Endeavor Health; Arlington Heights (IL); On-site; USD 30,500 - 45,750; Full time

Benefits offered by this job

Shift pay

On-call pay

Holiday pay

Annual increases based on performance

Career growth opportunities

Medical, dental, vision options

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

Endeavor Health in Arlington Heights, IL seeks a Denial Management Specialist to review and resolve denied patient insurance claims, focusing on medical necessity, pre-certification, authorization, and level of care requirements. In this role you will collaborate with Physician Practices, Providers and Payers, submit timely appeals, gather medical records, and write appeal letters.

Strong computer skills and knowledge of CPT/ICD9 coding are required; high school diploma and 2 years of relevant

Qualifications

• High School diploma required.
• 2 years of patient billing or managed care experience preferred.
• Strong computer skills and knowledge of billing guidelines.

Responsibilities

• Review and resolve denied patient insurance claims.
• Collaborate with internal departments to determine denial appeal process and gather necessary information.
• Submit timely appeals by resubmitting corrected claims, medical records, and appeal letters.
• Provide process improvement recommendations to reduce future denials.
• Use software tools to identify denial trends and payer issues; share findings with stakeholders.
• Follow up on pending denials after appeals are processed with payers.

Skills

Computer skills

Billing guidelines

CPT/ICD9 coding

U&C schedules

Education

High School diploma

Job description

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

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 Opportunities

EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.