Payer Reimbursement Specialist

Eisenhower Medical Center; United States; On-site; USD 30,000 - 46,000; Full time

Job summary

Eisenhower Health Careers in the United States seeks a dedicated Case Management/Denials Specialist to help secure payer reimbursements. You will collaborate with the Case Management team, appeal denials, and ensure timely authorization and proper documentation in EPIC.

Qualified candidates have a billing background focused on Managed Care and denials processing, with strong analytical skills and proficiency in Excel and EPIC. This role reports to the Director of Case Management.

Qualifications

• High School diploma or equivalent required; associate degree preferred.
• Two years billing background with emphasis in Managed Care denial follows up and appeals processing.
• Prior hospital billing experience is a plus; patient accounting background in high-volume settings preferred.

Responsibilities

• Demonstrates compliance with Code of Conduct and compliance policies.
• Reviews patient accounts to ensure clinical reviews are submitted to payer.
• Follows up with payer regarding authorized days and documents in EPIC.
• Checks voicemails and faxes for payer requests and routes to appropriate staff.
• Responds to insurance company requests and communicates authorization status.
• Sends IEHP list of patients needing clinical and/or Discharge Summary.
• Obtains insurer approvals and updates systems accordingly.
• Receives payer information via email and routes to the Case Managers.
• Submits denials to the Clinical Appeal Nurse and notifies CM Manager if needed.
• Reviews Outlier report weekly and updates payer information.
• Assists Clinical Appeal Nurse with processing appeals.

Education

High School diploma or equivalent

Associate degree

Tools

EPIC

Windows

Excel

Job description

Eisenhower Health Careers in the United States seeks a dedicated Case Management/Denials Specialist to help secure payer reimbursements. You will collaborate with the Case Management team, appeal denials, and ensure timely authorization and proper documentation in EPIC.

Qualified candidates have a billing background focused on Managed Care and denials processing, with strong analytical skills and proficiency in Excel and EPIC. This role reports to the Director of Case Management.