Care Management Specialist

Hourly Pay Range: $22.14 - $33.21 - The hourly pay rate offered is determined by a candidate’s expertise and years of experience, among other factors. Position Highlights: Position: Denial Management Specialist Location: Arlington Heights, IL Full Time/Part Time: Full Time Hours: Monday-Friday, standard business hours A Brief Overview: 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. What you will need: Education: High School Required Experience: 2 Years previous patient billing Or 2 Years managed care experience Skills: Extensive computer knowledge and experience. Knowledge of standard billing guidelines, CPT/ICD9 coding, usual and customary (U& C) schedules Benefits (For full time or part time positions): Premium pay such as shift, on call, holiday and more based on an employee’s job (For eligible positions) Incentive pay for select positions Opportunity for annual increases based on performance Career Pathways to Promote Professional Growth and Development Various Medical, Dental, Pet and Vision options Tuition Reimbursement Free Parking Wellness Program Savings Plan Health Savings Account Options Retirement Options with Company Match Paid Time Off and Holiday Pay Community Involvement Opportunities Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential. Please explore our website to better understand how Endeavor Health delivers on its mission to “help everyone in our communities be their best”. Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information. At Endeavor Health, we are united by a shared commitment to working together to create a culture of connection and belonging - each of us bringing different skills and experiences as we deliver safe, seamless, and personal care. Every person, every time. We are committed to fostering an environment where all team members can be their best, learn, and pursue excellence together. EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor. #J-18808-Ljbffr