Denials Specialist

The LaSalle Network; Skokie (IL); On-site; USD 34,000 - 39,000; Full time

Job summary

LaSalle Network is hiring a Denials Specialist in Skokie, IL for a contract-to-hire role. You will manage denial and appeal workflows, audit data accuracy, and perform root-cause analyses to reduce denials while aligning with CMS requirements.

The position requires 3+ years in denial management or related health-care roles, Epic experience, and strong Excel and Office skills. This is an on-site opportunity to support reimbursement across payor types.

Qualifications

• High school diploma or equivalent required; associate degree in business, accounting or health care, or bachelor’s degree preferred.
• Minimum three years of experience in adjudication, reimbursement, denial management, utilization review or equivalent in a health care environment.
• Epic experience required.
• Knowledge of reimbursement models and related federal, state and regulatory rules and regulations (including Medicare, Medicaid and managed care).
• Proficiency with Microsoft Office products and familiarity with claims processing and coding concepts (CPT, HCPCS, DRGs and ICD-9/10).

Responsibilities

• Oversee denial and appeal workflows using the denial management system, including documentation, deadline tracking and timely payment/adjustment processing
• Audit denial data to correct errors, maintain data integrity and develop standard and ad-hoc reports to identify trends and variances
• Perform root-cause analysis on denials and provide feedback and education to departments and physician offices to reduce denials and improve processes
• Maintain current knowledge of Medicare, Medicaid and managed care requirements, including monitoring CMS guidance and industry changes
• Serve as a liaison across hospital departments and off-site facilities to support denial prevention and optimal reimbursement
• Perform RAC account review and reconciliation, including appeals for medically unlikely edits (MUE) rejections and related adjustments/refunds as appropriate
• Complete adjudication-related work, including calculating allowances, identifying contract inconsistencies and correcting account/insurance errors

Skills

Denials management

Healthcare reimbursement

CMS guidelines

Analytical skills

Communication/writing

Excel

Epic experience

Cobius

AEOS

Claims processing knowledge

CPT/HCPCS/DRGs/ICD-9/10

Education

High school diploma

Associate degree in health care or business

Tools

Cobius

AEOS

Word

Access

Excel

Job description

Denials Specialist (162628) Skokie, Illinois

Salary: USD25 - USD28 per hour

LaSalle Network is partnering with our client to hire a Denials Specialist in Skokie, Ill., for a contract-to-hire opportunity. This Denials Specialist role is ideal for someone who enjoys blending denial and appeal work with data integrity, reporting and cross-functional collaboration. In this on-site environment, the Denials Specialist will support denial prevention and revenue protection across multiple payor types while staying current on evolving regulatory requirements.

Responsibilities

• Oversee denial and appeal workflows using the denial management system, including documentation, deadline tracking and timely payment/adjustment processing
• Audit denial data to correct errors, maintain data integrity and develop standard and ad-hoc reports to identify trends and variances
• Perform root-cause analysis on denials and provide feedback and education to departments and physician offices to reduce denials and improve processes
• Maintain current knowledge of Medicare, Medicaid and managed care requirements, including monitoring CMS guidance and industry changes
• Serve as a liaison across hospital departments and off-site facilities to support denial prevention and optimal reimbursement
• Perform RAC account review and reconciliation, including appeals for medically unlikely edits (MUE) rejections and related adjustments/refunds as appropriate
• Complete adjudication-related work, including calculating allowances, identifying contract inconsistencies and correcting account/insurance errors

Qualifications

• High school diploma or equivalent required; associate degree in business, accounting or health care, or bachelor\'s degree preferred
• Minimum three years of experience in adjudication, reimbursement, denial management, utilization review or equivalent experience in a health care environment

Epic experience required

• Knowledge of reimbursement models and related federal, state and regulatory rules and regulations (including Medicare, Medicaid and managed care)
• Proficiency with Microsoft Office products
• Familiarity with claims processing and coding concepts (CPT, HCPCS, DRGs and ICD-9/10)
• Strong analytical, critical thinking, communication and writing skills, including the ability to draft clear, persuasive appeal letters
• Intermediate to advanced computer skills and the ability to navigate multiple systems and payer portals; experience with tools such as Cobius, AEOS, Word, Access and Excel is beneficial
• Ability to manage workload through automated processes, multitask effectively and work a flexible schedule

About LaSalle Network

At LaSalle Network, we don\'t just fill roles - we build careers and transform businesses. As one of the nation\'s leading staffing and solutions firms, we connect exceptional talent with organizations that value innovation, collaboration, and growth. Whether you\'re looking to take the next step in your career or find the perfect addition to your team, we make meaningful matches that last. Join us and experience a company consistently recognized as a top workplace - because when our people thrive, everyone wins.