Patient Financial Services Denial Specialist – Full-Time, Days

Job Description:

You may be based outside of the greater Chicagoland area.

The denial analyst has a working knowledge of state/federal laws that relate to contacts and to the appeals process. Maintains and monitors integrity of the claim development and submission process.

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to and/or resolving appeals with third-party payers in a timely manner. Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Works closely with insurance and managed care companies to ensure proper review and processing of denied claims
• Acts as a liaison between insurance companies and physicians to provide medical necessity for denied claims
• Identifies and tracks payer denials trends and works with the payers to correct any erroneous denials and works with the departments to review and improve processes to avoid these denials in the future
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Contacts patients to communicate insurance coverage denials and works with the patient to overturn the denials related to patient information needed
• Works closely with Denial Manager to provide key information for the Denial Task Force Meetings. Complies with State and Federal regulations, accreditation/compliance requirements, and Ingalls Memorial Hospital policies, including those regarding fraud and abuse, confidentiality, and HIPAA. Maintains current knowledge of rules and regulations of third party payers. Performs related duties as required

• High school diploma or equivalent
• Minimum 3 years of experience in healthcare billing, collections, payment processing, or denials management (Denial Management experience preferred).
• Minimum 3 years of experience using computer programs for tracking denials and appeals
• Demonstrated knowledge of: Hospital billing and reimbursement, Medicare and Medicaid denials and appeals, third-party contracts, NCQA guidelines for denials and appeals, federal and state regulations relating to denials and appeals, proven critical thinking and analytical skills, proficient organizational skills and attention to detail, strong writing and communication skills, high level of comfort with computer systems

• Job Type: Full Time (1.0 FTE)
• Shift: Days
• Work Location: Flexible Remote – Burr Ridge
• Department: Revenue Cycle
• CBA Code: Non-Union

Why Join Us:

Here at Ingalls, we’re doing work that really matters. Join us!

UChicago Medicine Ingalls Memorial is growing; discover how you can be a part of this pursuit of excellence at: Ingalls Career Opportunities

UChicago Medicine Ingalls is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.