PFS Denial Specialist, Full time - Days

University of Chicago • Burr Ridge, IL

117d • Remote

About The Position

Join Ingalls Memorial Hospital as a Patient Financial Services Denial Specialist. Here, you will join our Revenue Cycle team at our Burr Ridge location. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area. Under general direction, the Patient Financial Services Denial Specialist is responsible for reviewing denied claims and carrying out the appeals process for Ingalls Memorial Hospital. This position works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence, and possibly setting up arbitration between parties. 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.

Requirements

• 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.

Responsibilities

• 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.

Benefits

• Comprehensive health insurance.
• 401k plan.
• Paid time off.
• Flexible work arrangements.
• Professional development opportunities.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Educational Services
• Education Level: High school or GED