Denial Collections Specialist

Francisan Health•Home, PA

49d•$16 - $20•Remote

About The Position

The Denial Collections Specialist is responsible for the immediate review of all denied medical insurance claims, identification of the basis for filing an appeal, and/or resubmission of claims. This position ensures that resubmitted claims are accurate, compliant and timely, resulting in reconsideration by third-party payers. WHO WE ARE With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT Reports and uses software to track, trend and identify root causes of denials; offers suggestions for process improvement to resolve denial issues, supported by documentation and data. Collaborates with other departments to align interdepartmental functioning, goals, and expectations. Ensures all clinical denials assigned to Clinicians, Patient Access and/or HIM denial staff are acknowledged in a timely manner, and appropriate follow-up action is taken as defined by the respective policy. Conducts follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed in order to properly review, dispute or appeal denial until a determination is made to conclude the appeal. Completes write-offs per policy and/or reassign remaining balances to respective departments. Ensures that follow-up responses on denied claims occur on a timely basis and adhere to contractually binding conditions. Resubmits overturned denials as warranted, and monitors denial resubmissions for payment. Resubmits claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form. Performs reconsiderations and appeals on Payor websites or with appropriate Payor required documentation. Ensures compliance with all state and federal billing regulations. Reports any suspicious activities to leadership. Performs RAC Audits utilizing appropriate software and documents findings (ABO Only). Performs recoupments to include investigating claim and payment history to see if the appeal is warranted. Collects documentation and submits write-off if appropriate (ABO Only). Rejected Claim Review Reviews rejected claims based on NPI denials (ABO Only).

Requirements

High School Diploma/GED
1 year Patient Accounting Required

Nice To Haves

Associate's Degree

Responsibilities

Reports and uses software to track, trend and identify root causes of denials; offers suggestions for process improvement to resolve denial issues, supported by documentation and data.
Collaborates with other departments to align interdepartmental functioning, goals, and expectations.
Ensures all clinical denials assigned to Clinicians, Patient Access and/or HIM denial staff are acknowledged in a timely manner, and appropriate follow-up action is taken as defined by the respective policy.
Conducts follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed in order to properly review, dispute or appeal denial until a determination is made to conclude the appeal.
Completes write-offs per policy and/or reassign remaining balances to respective departments.
Ensures that follow-up responses on denied claims occur on a timely basis and adhere to contractually binding conditions.
Resubmits overturned denials as warranted, and monitors denial resubmissions for payment. Resubmits claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form.
Performs reconsiderations and appeals on Payor websites or with appropriate Payor required documentation.
Ensures compliance with all state and federal billing regulations. Reports any suspicious activities to leadership.
Performs RAC Audits utilizing appropriate software and documents findings (ABO Only).
Performs recoupments to include investigating claim and payment history to see if the appeal is warranted.
Collects documentation and submits write-off if appropriate (ABO Only).
Rejected Claim Review Reviews rejected claims based on NPI denials (ABO Only).