Denials Management Specialist NE
- Warrenville, IL
- Permanent
- Full-time
- Position: Denial Management Specialist
- Location: Warrenville IL
- Full Time/Part Time: Full Time
- Hours: Monday-Friday, 8am-430pm
Reviews claim denials which pertain to medical necessity, pre-certification, authorization, and level of care requirements. This involves interaction with Physician Practices, Providers and Payers.What you will do:
- Reviews and resolves denied patient insurance claims.
- Works closely with internal departments in determining accurate denial and process for appeal. Contacts insurance companies/payer or patients to gather information necessary to complete the appeal process.
- Sends appeals to insurance companies regarding denials by resubmitting corrected claim, submitting medical records and writing appeals letters in a timely manner
- Provides process improvement recommendations to Supervisor to decrease future denials.
- Utilizes software tools to identify denial, trends and payer issues. Shares findings with stakeholders.
- Follows up on pending claim denials after appeal has been processed -by the insurance company.
- Collaborates in the collection of data and sends monthly “Managed Care Denial Report” to appropriate department Leaders including: Physician Coding Manager; Physician Billing Manager and Director, VP of EEH Physician Practices and Vice President of EEH Revenue Cycle.
- Maintains positive working relationships both externally and internally.
- High School Required
- 2 Years previous patient billing Or 2 Years managed care experience
- Extensive computer knowledge and experience
- Knowledge of standard billing guidelines, CPT/ICD9 coding, usual and customary (U& C) schedules
- Career Pathways to Promote Professional Growth and Development
- Various Medical, Dental, and Vision options
- Tuition Reimbursement
- Free Parking at designated locations
- Wellness Program Savings Plan
- Health Savings Account Options
- Retirement Options with Company Match
- Paid Time Off and Holiday Pay
- Community Involvement Opportunities