St. Elizabeth Healthcare is on a mission to provide patients with compassionate and comprehensive care. As an employer, the company aims to foster a culture where team members valu
Technical Denial Specialist
Location
United States
Posted
6 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Technical Denial Specialist
St. Elizabeth Healthcare
Role Description The Technical Denials Specialist is responsible for analyzing, resolving, monitoring, and reporting non-clinical denials to the Denials Unit Manager as appropriate. The role supports the mission, vision, values, and strategies of St. Elizabeth Healthcare. - Demonstrate respect, dignity, kindness, and empathy in each encounter with all patients, families, visitors, and other employees regardless of cultural background. - Reviews, researches, and addresses non-clinical denials. - Addresses all accounts assigned to work queue and completes all necessary activity as defined in departmental policies and procedures. - Performs extensive follow-up, completes appeals, and refers to other stakeholders when appropriate. - Investigates and ensures that questions and requests for information are responded to in a timely and professional manner. - Performs ongoing monitoring of denials accounts worked to maximize collection dollars. - Utilizes all appropriate systems to effectively research accounts and complete necessary steps. - Completes follow-up with patients to obtain additional information as necessary. - Prepares necessary documentation to submit appeals to payers when payment is denied. - Completes all necessary outgoing calls and answers incoming calls as appropriate. - Requests rebilling of accounts as necessary. - Completes and/or requests adjustments to an account based on adjustment thresholds. - Reviews, works, and reports all accounts that have aged more than the specified grace period. - Documents follow-up or patient accounts appropriately. - Tracks and reports violations of prompt pay/adjudication terms by payers. - Interfaces with other key internal and external staff to obtain necessary information. - Reports issues and trends to appropriate management personnel and collaborates to develop solutions. - Participates in all educational activities and demonstrates personal responsibility for job performance. - Meets or exceeds expectations for data quality, customer service, payment variance management turnaround, and productivity. - Maintains satisfactory attendance and punctuality as set forth by St. Elizabeth Healthcare and departmental policies. - Consistently demonstrates a positive and professional attitude at work. - Maintains stable performance under pressure. - Prioritizes work/resources to accomplish objectives and meet deadlines. - Maintains compliance with federal, state, and local regulations and HIPAA. - Maintains the privacy and security of all confidential and protected health information. - Performs other duties as assigned. Qualifications - Associates degree OR High School Diploma plus Certified Revenue Cycle Representative and 3 years of related experience. Requirements - Demonstrates proficiency in Microsoft Office applications and others as required. - Demonstrates knowledge and understanding of organizational policies and procedures. - Knowledge of insurance regulations, payment guidelines, and policies. - Extensive knowledge of Medicare and Medicaid regulations. - Knowledge of third-party claim filing, contract reimbursement, and other insurance guidelines. Benefits - Competitive pay and comprehensive health coverage within the first 30 days. - Generous paid time off and flexible work schedules. - Retirement savings with employer match. - Tuition reimbursement and professional development opportunities. - Wellness, mental health, and recognition programs. - Career advancement through mentorship and internal mobility.
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