Professional Billing Denials Specialist, Full-time, Days

Northwestern Memorial Healthcare • Warrenville, IL

22h • $20 - $30

About The Position

The Professional Billing Denials Specialist supports Northwestern Medicine’s patient-first mission and follows the organization’s Code of Ethics, Corporate Compliance Program, policies, procedures, and applicable regulatory and accreditation standards. The role resolves claim edits and denials, supports timely and accurate claim submission, and follows up on third-party payer receivables and appeals. The specialist works toward department accounts receivable goals while observing HIPAA privacy standards and applicable payer and government guidelines.

The position requires proficient use of assigned hospital and external software applications, computer hardware, and established processes. The specialist contributes to system and process improvements, participates in software testing and training, and assists the Patient Accounting Operational Coordinator and Patient Accounting Team Lead Financial Assessor with projects and other assigned duties. Excellent customer service and communication with patients, authorized guarantors, and internal and external contacts are important aspects of the role.

Requirements

• High school diploma.
• One year of related work experience or a college degree.
• Ability to perform mathematical calculations.
• Basic knowledge of medical terminology and billing practices.
• Extensive experience and knowledge of PC applications, including Microsoft Office and Excel.
• Ability to learn quickly and meet continuous timelines.
• Behaviors consistent with principles of excellent service.

Nice To Haves

• Two or more years of college or a college degree.
• Call center, telephone, or cash collections experience.
• Knowledge of Epic Systems.
• Two years of progressive work experience in a hospital or physician billing or SBO environment.
• Detail orientation, good organizational skills, and ability to work independently.
• Strong time-management skills and ability to manage multiple priorities and a heavy workload in a high-stress environment.
• Flexibility to perform other tasks as needed in an active work environment with changing work needs.
• High-level problem-solving, analytical, and investigative skills.
• Excellent internal and external customer service skills.

Responsibilities

• Meet productivity and quality standards for timely claim-edit resolution, claim submission, documentation requirements, and related claim communications, ensuring claims are timely, clean, complete, and accurate.
• Meet or exceed assigned productivity standards, targets, error ratios, and reporting requirements.
• Follow up on and collect third-party payer receivables; pursue denials and appeals, analyze root causes, and work to overturn denials and resolve payment issues.
• Send compliant follow-up correspondence to third-party payers regarding outstanding accounts receivable.
• Support operations for third-party accounts receivable, including managed care, commercial, Medicare, Medicaid, replacement plans, workers’ compensation, corporate, research, and specialty accounts.
• Review work lists daily and systematically, and complete all accounts ready to be worked.
• Use government, commercial, and regulatory guidelines to collect outstanding accounts; recommend contractual or administrative write-offs with appropriate justification and documentation.
• Follow HIPAA privacy standards and protect patient health information while contributing to department accounts receivable goals.
• Identify opportunities to improve customer service, systems, and processes and submit them to management.
• Follow general and departmental policies and procedures, emergency preparedness procedures, and Joint Commission and other regulatory requirements.
• Use assigned menus and pathways in hospital and external software applications, report application problems to the appropriate supervisor, and use assigned computer hardware while reporting hardware problems.
• Participate in testing assigned software applications, including verification of field integrity.
• Assist the Patient Accounting Operational Coordinator and Patient Accounting Team Lead Financial Assessor with special projects and other duties as assigned.
• Attend training and seminars as assigned and approved by the Patient Accounting Operations Coordinator.
• Provide excellent oral and written customer service to patients, authorized guarantors, and other internal and external contacts.
• Demonstrate proficient use of systems and execution of processes across assigned responsibilities.

Benefits

• Tuition reimbursement
• Loan forgiveness
• 401(k) matching
• Lifecycle benefits
• A range of benefits supporting physical, emotional, and financial well-being and protection for unexpected life events

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED