Denial Management Specialist-Cert CPFSS (HB)
About The Position
Under the direction of the PB Follow Up & Denial Team Supervisor, the PB Follow Up & Denial Team Member is responsible for monitoring claims for Medicare, Medicaid, Government Payors, Commercial Payors and Work Comp Payors through claim follow up and insurance appeals. Essential Job Duties: Researches and analyzes denial data and coordinates denial recovery responsibilities. Identifies, analyzes, and researches frequent root causes of denials and recommends corrective action plans for resolution of denials. Prioritizes activities to work overturns in a timely manner to alleviate untimely filings. Uses WQ sort/filter options to categorize denials to work to overturn denials. Researches, responds, and documents insurer correspondence /inquiry notes regarding coding, coverage, benefits, and reimbursement on patient accounts timely and accurately. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks. Helps with coverage for Customer Service when needed. Receive a passing score on the annual competency evaluation. Demonstrates knowledge of patient confidentiality and HIPAA regulations. Organized; sets priorities; meets deadlines Demonstrates knowledge of assigned payor processes for follow up and denials and is able to navigate the payor provider portals easily. Is a team player and communicates well with others. Must obtain CPFSS (Certified Patient Financial Service Specialst) certification within 3-6 months upon hire date. Uses sort/filter options to determine priority of working claims in the Follow Up WQ by timely filing deadline and balance. Secondary Job Duties That May be Reassigned: Process payor refunds Answers and directs phone calls Updates job knowledge by participating in educational opportunities Complete Wellness Matters adjustments Print paper claims and document claim run totals Attach electronic medical records to claims in Waystar Why Choose Good Samaritan? For more than 115 years, Good Samaritan has been dedicated to not only providing trusted, industry-leading health care, but to fill a vital role in southwest Indiana and southwest Illinois. Our hospital continues to adhere to the compassionate principles our facility was founded on and further our commitments to our patients, our staff, and the communities we serve. Good Samaritan is well recognized for its commitment to excellence as a 4-time designated Magnet® facility, TJC Primary Stroke Center, and a Level III Trauma Center. We would love to welcome you to our Good Samaritan family. Join Our Team Good Samaritan is looking for compassionate, caring, and dedicated caregivers to join our team and help us continue our tradition of excellence.
Requirements
- Must obtain CPFSS (Certified Patient Financial Service Specialst) certification within 3-6 months upon hire date.
Responsibilities
- Researches and analyzes denial data and coordinates denial recovery responsibilities.
- Identifies, analyzes, and researches frequent root causes of denials and recommends corrective action plans for resolution of denials.
- Prioritizes activities to work overturns in a timely manner to alleviate untimely filings.
- Uses WQ sort/filter options to categorize denials to work to overturn denials.
- Researches, responds, and documents insurer correspondence /inquiry notes regarding coding, coverage, benefits, and reimbursement on patient accounts timely and accurately.
- Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks.
- Helps with coverage for Customer Service when needed.
- Receive a passing score on the annual competency evaluation.
- Demonstrates knowledge of patient confidentiality and HIPAA regulations.
- Organized; sets priorities; meets deadlines
- Demonstrates knowledge of assigned payor processes for follow up and denials and is able to navigate the payor provider portals easily.
- Is a team player and communicates well with others.
- Must obtain CPFSS (Certified Patient Financial Service Specialst) certification within 3-6 months upon hire date.
- Uses sort/filter options to determine priority of working claims in the Follow Up WQ by timely filing deadline and balance.
- Process payor refunds
- Answers and directs phone calls
- Updates job knowledge by participating in educational opportunities
- Complete Wellness Matters adjustments
- Print paper claims and document claim run totals
- Attach electronic medical records to claims in Waystar
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
