Denials 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: 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. Responsibilities Reviews and resolves denied patient insurance claims. Works closely with internal departments to determine 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. Qualifications 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 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 EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor. #J-18808-Ljbffr 1201 Northwest Community Hospital