Denials Management Specialist

1201 Northwest Community Hospital; Arlington Heights (IL); On-site; USD 31,000 - 46,000; Full time

Benefits offered by this job

Shift pay

On-call pay

Holiday pay

Tuition Reimbursement

Free Parking

Wellness Program

Job summary

Endeavor Health Careers is seeking a Denial Management Specialist in Arlington Heights, IL. You will review denied patient insurance claims, coordinate with internal departments, and contact payers or patients to gather information for appeals.

The role requires a High School education and at least 2 years in patient billing or managed care, with strong computer skills and knowledge of CPT/ICD9 coding. We offer comprehensive benefits and growth opportunities.

Qualifications

• Education: High School
• Experience: 2 years in patient billing or 2 years managed care
• Skills: Extensive computer knowledge; CPT/ICD9 coding; knowledge of standard billing guidelines; U&C schedules

Responsibilities

• 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.

Skills

Extensive computer knowledge

CPT/ICD9 coding

U & C schedules

Education

High School

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

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

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 Endeavor 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.

Company Welcome

Welcome to Endeavor Health Careers At Endeavor Health, we believe every role plays an important part in advancing our mission to help everyone in our communities be their best. Whether you’re just beginning your career journey or are a seasoned professional, you’ll find opportunities here to learn, grow, and thrive. Your Career is our Endeavor.

Endeavor Health

For more information, visit www.endeavorhealth.org. When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential. Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to “help everyone in our communities be their best”. Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information. At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging—each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together.

EOE Statement

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