Denial Reimburse Specialist
About The Position
Some people love getting to the bottom of things -- chasing down denied claims, resolving accounts, digging through the details to identify discrepancies and needs. Yes, we’re talking about people who love collections. And it takes a love of getting into the details to do this job well. 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 Conduct inquiries via phone, mail, fax, or electronically to conduct follow-up on the accounts that have not been denied and resubmitted for payment. Conduct 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. Resubmit overturned denials as warranted and monitor denial resubmissions for payment; resubmit claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form. Ensure information sent to insurance carriers have all release of information necessary and is HIPPA compliant. Analyze reports and use software to track, trend and identify root causes of denials; offer suggestions for process improvement to resolve denial issues, supported by documentation and data. Review denials and payment discrepancies identified through the denial system, which are directly related to the verification, authorization and registration process. Prepare and submit patient record requests from care delivery sites and provide correspondence to patient on requested information.
Requirements
- High School Diploma/GED
- 2 years Revenue Cycle
Nice To Haves
- Associate's Degree
Responsibilities
- Conduct inquiries via phone, mail, fax, or electronically to conduct follow-up on the accounts that have not been denied and resubmitted for payment.
- Conduct 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.
- Resubmit overturned denials as warranted and monitor denial resubmissions for payment; resubmit claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form.
- Ensure information sent to insurance carriers have all release of information necessary and is HIPPA compliant.
- Analyze reports and use software to track, trend and identify root causes of denials; offer suggestions for process improvement to resolve denial issues, supported by documentation and data.
- Review denials and payment discrepancies identified through the denial system, which are directly related to the verification, authorization and registration process.
- Prepare and submit patient record requests from care delivery sites and provide correspondence to patient on requested information.
Benefits
- Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
