Specialist Technical Denial

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Job Type: Regular

Scheduled

Hours:

40 hours weekly

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 are 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.

• 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.

The Technical Denials Specialist is responsible for analyzing, resolving, monitoring, and reporting non‑clinical denials to the Denials Unit Manager. The Specialist follows up and resolves denials escalated through a work queue, provides appropriate denial information to be submitted to departments, and ensures 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 Specialist must remain in full compliance with all departmental, institutional, and regulatory policies and procedures at all times. The role supports the mission, vision, values, and strategies of St. Elizabeth Healthcare.

• Reviews, researches, and addresses non‑clinical denials.
• Addresses all accounts assigned to the work queue and completes all necessary activities 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 to resolve outstanding accounts.
• Performs ongoing monitoring of denied accounts to maximize 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.
• Completes all necessary outgoing calls and answers incoming calls, as appropriate.
• Makes revisions or changes to insurance information, as appropriate.
• Requests the re‑billing of accounts as necessary.
• Completes and/or requests 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 violations of prompt pay/adjudication terms by payers and follows up proactively to provide necessary additional documentation for patient accounts awaiting 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 appropriate management personnel and works collaboratively 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 records 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…