Specialist Technical Denial

SEH Saint Elizabeth Medical Center, Inc.; United States; Remote; USD 60,000 - 80,000; Full time

Benefits offered by this job

Competitive pay

Health coverage

Paid time off

Retirement match

Tuition reimbursement

Wellness programs

Career advancement

Job summary

St. Elizabeth Healthcare is hiring a Technical Denials Specialist to analyze, resolve and monitor non-clinical denials. The role is full-time with a 40-hour work week and will be remote after an initial training period.

Responsibilities include extensive follow-up, submitting payer appeals, and ensuring timely resolutions to improve collections. Qualified candidates will have an associates degree or high school diploma with Revenue Cycle Certification and 3 years in related experience, plus

Qualifications

• Associates degree or high school diploma with Revenue Cycle Certification and 3 years of related experience.
• Experience in denial management and healthcare billing environment.

Responsibilities

• Analyze, resolve and follow up on non-clinical denials.
• Prepare and submit appeals and referrals to payors.
• Research accounts and document actions taken for accurate processing.
• Coordinate with internal/external staff to resolve variance and ensure timely adjudication.

Skills

Microsoft Office

Insurance regulations

Medicare/Medicaid knowledge

Communication with payors

Payment variance management

Education

Associates degree or high school diploma + Revenue Cycle Certification

Tools

Microsoft Office

Job description

Why You’ll Love Working with St. Elizabeth Healthcare

At St. Elizabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We’re guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork. Our associates are the heart of everything we do.

Benefits That Support You

We invest in you — personally and professionally.

• Competitive pay and comprehensive health coverage within the first 30 days.
• Generous paid time off and flexible work schedules
• Retirement savings with employer match
• Tuition reimbursement and professional development opportunities
• Wellness, mental health, and recognition programs
• Career advancement through mentorship and internal mobility

Job Summary

Job Type: Regular Scheduled Hours: 40

St. Elizabeth is hiring a Technical Denials Specialist! This position is remote after an initial training period and will be full‑time dayshift. The Technical Denials Specialist is responsible for analyzing, resolving, monitoring and reporting non‑clinical denials to Denials Unit Manager as appropriate. The Technical Denial Specialist is responsible for follow‑up and resolutions for denials escalated through a work queue, providing appropriate denial information to be submitted to departments to ensure systems, processes and measures of effectiveness (e.g. Remediation action plans) are created and implemented to resolve root cause issues, reviews and resolves technical denials received post service, and reduce/ eliminate denials. The Technical Denial Specialist should remain in full compliance with all departmental, institutional and regulatory policies and procedures at all times. The roles and responsibilities of this job support the mission, vision, values and strategies of St. Elizabeth Healthcare. Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

Job Description

Reviews, researches and addresses non‑clinical denials. Addresses all accounts assigned to work queues and completes all necessary activity as defined in departmental policies and procedures. Performs extensive follow‑up, completes appeals and referrals to other stakeholders, when appropriate. Investigates and/or ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding accounts. Performs ongoing monitoring of denials accounts worked, as necessary, to ensure maximization of collection dollars by providing appropriate follow‑up and documenting actions taken. Utilizes all appropriate systems to effectively research accounts and complete steps to submit information necessary to process or appeal accounts. Completes follow‑up with patients, as necessary, to obtain additional information. Prepares necessary documentation to submit appeals to payers when payment is denied including escalation through payer joint operating calls. Complete all necessary outgoing calls and answer incoming calls, as appropriate. Make revisions or changes to insurance information, as appropriate. Requests the rebilling accounts as necessary. Complete and/or request adjustments to an account, as appropriate, based on adjustment thresholds. Reviews, works and reports (with accuracy) all accounts that have aged more than the specified grace period stipulated in the policies and/or contracts. Documents follow‑up or patient accounts appropriately. Tracks and reports violation of prompt pay/adjudication terms by payers and follows up proactively with payers to provide necessary additional documentation for patient accounts that have been reviewed by payers and awaiting documentation to determine adjudication. Interfaces with other key internal and external staff to obtain necessary information to address payment variance management issues or requests. Reports issues and trends to appropriate management personnel and works collaboratively to develop solutions. Reports issues and trends to appropriate management personnel and works collaboratively to develop solutions. Facilitate joint operating calls for assigned payer with the support of department leadership in addition to managing plan spreadsheets, coordinating meeting times, submitting meeting agenda and ensuring any information requested by the plans provider representative is delivered in a timely manner. Participates in all educational activities and demonstrates personal responsibility for job performance. Meets or exceeds expectations for data quality, customer service, payment variance management turnaround and productivity. Maintains satisfactory attendance record and punctuality record as set forth by St. ElizabethHealthcare and departmental policies. Consistently demonstrates a positive and professional attitude at work. Maintains stable performance under pressure. Prioritizes work/resources to accomplish objectives and meet deadlines. Maintains compliance with federal, state and local regulations and HIPPA. Maintains the privacy and security of all confidential and protected health information; job duties warrant a “high”level of computer system access (all necessary areas) to patient information ONLY for those job functions as outlined in this job description; uses and discloses only that information which is necessary to perform the function of the job. Performs other duties as assigned.

Education, Credentials, Licenses

Associates degree OR High School Diploma plus Certified Revenue Cycle Representative and 3 years of related experience.

Specialized Knowledge

• Demonstrates proficiency in Microsoft Office applications and others as required
• Demonstrates knowledge and understanding of organizational policies and procedures
• Knowledge of insurance regulations, payment guidelines and policies and the ability to communicate and work with payors to get accounts resolved and paid accurately
• Extensive knowledge of Medicare and Medicaid regulations
• Knowledge of third Party claim filing, contract reimbursement and other insurance guidelines

Kind and Length of Experience

3 years’ experience including customer service etiquette and interaction with internal and external.

FLSA Status

Non-Exempt Right Career.

Right Here

If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community. St. Elizabeth Healthcare is one of the oldest, largest and most respected medical providers in the Northern Kentucky, southeastern Indiana and Greater Cincinnati region. Together with St. Elizabeth Physicians, the affiliated multi‑specialty physician and advanced practice provider organization, we are transforming healthcare through innovative treatments, cutting‑edge technology and a heart for our community. We’re right here, sharing one mission: to improve the health of the people we serve.