Specialist Technical Denial

Specialist Technical Denial page is loaded## Specialist Technical Denial locations:
Erlanger, Kentuckytime type:
Full time posted on:
Posted Todayjob requisition :
JR309485
** Engage with us for your next career opportunity. Right Here.
**** Job Type:
** Regular
* * Scheduled

Hours:

** 40
* * Why You’ll Love Working with St. Elizabeth Healthcare
** zabeth Healthcare, every role supports our mission to provide comprehensive and compassionate care to the communities we serve. For more than 160 years, St. Elizabeth Healthcare has been a trusted provider of quality care across Kentucky, Indiana, and Ohio. We’re guided by our mission to improve the health of the communities we serve and by our values of excellence, integrity, compassion, and teamwork.

Our associates are the heart of everything we do.
** Benefits That Support You
** We invest in you — personally and professionally.

Enjoy:

- 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
*
* Job Summary:

** The Technical Denials Specialist is responsible for analyzing, resolving, monitoring and reporting non-clinical denials to Denials Unit Manager as appropriate. The Technical Denial Specialist is responsible for follow-up and resolutions for denials escalated through a work queue, providing appropriate denial information to be submitted to departments to ensure systems, processes and measures of effectiveness (e.g. Remediation action plans) are created and implemented to resolve root cause issues and reduce/ eliminate denials.

The Technical Denial Specialist should remain in full compliance with all departmental, institutional and regulatory policies and procedures at all times. The roles and responsibilities of this job support 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.
*
* Job Description:

*** 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 referrals to other stakeholders, when appropriate.
* Investigates and/or ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding accounts.
* Performs ongoing monitoring of denials accounts worked, as necessary, to ensure maximization of collection dollars by providing appropriate follow-up and documenting actions taken.
* Utilizes all appropriate systems to effectively research accounts and complete steps to submit information necessary to process or appeal accounts.
* Completes follow-up with patients, as necessary, to obtain additional information.
* Prepares necessary documentation to submit appeals to payers when payment is denied.
* Complete all necessary outgoing calls and answer incoming calls, as appropriate.
* Make revisions or changes to insurance information, as appropriate.
* Requests the rebilling accounts as necessary.
* Complete and/or request adjustments to an account, as appropriate, based on adjustment thresholds.
* Reviews, works and reports (with accuracy) all accounts that have aged more than the specified grace period stipulated in the policies and/or contracts.
* Documents follow-up or patient accounts appropriately.
* Tracks and reports violation of prompt pay/adjudication terms by payers and follows up proactively with payers to provide necessary additional documentation for patient accounts that have been reviewed by payers and awaiting documentation to determine adjudication
* Interfaces with other key internal and external staff to obtain necessary information to address payment variance management issues or requests.
* Reports issues and trends to…