Patient Accounts Denial Specialist-Patient Financial Services

Patient Accounts Denial Specialist-Patient Financial Services

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Job Details

System Services | Miamisburg | Full-Time | First Shift

• Identify, analyze, and research frequent root causes of denials and develop corrective action plans for resolution of denials.
• Formulate appeals, research and analyze denial data, and coordinate denial recovery responsibilities.
• Apply critical thinking skills to correct appeal methodology to address various denials such as proving medical necessity and retro authorizations appeals.
• Escalate outstanding denials, including submitting complaints to agencies such as the Ohio Department of Medicaid and the Department of Insurance.
• Investigate and appropriately address pre- and post-takebacks by health plans.
• Prioritize activities to work overturns in a timely manner to alleviate untimely filings.
• Work with insurance payers to ensure proper billing on all assigned patient accounts.
• Participate in conference calls, accounts receivable reports, compile issue reports to expedite resolution of accounts.
• Follow up daily reports, maintain established goals, and notify Team Lead and/or Supervisor of issues preventing achievement of such goals.
• Assist Customer Service with patient concerns/questions to ensure prompt and accurate resolution.
• Produce written correspondence to payers and patients regarding status of claim, requesting additional information, etc.
• Initiate next billing, assign appropriate follow-up and/or collection steps, including calling patients, insurers, or employers as appropriate.
• Send initial or secondary bills to insurance payers, documenting billing, follow-up and/or collection steps taken and all measures to resolve assigned accounts.
• Escalate to Supervisor/Manager any issues or changes in billing system, insurance carrier, and/or networks.
• Write appeals on denials including pre- and post-takebacks; contact payer to acquire status of submitted appeal; join payer calls and participate to address issues.

• High school Diploma or equivalent required.
• Minimum of a year working denials in the healthcare setting.
• Experience in Microsoft tools, Epic EMR Experience (preferred), Relay Health/ePremis Experience (preferred).
• Experience with the Revenue Cycle – registration, medical records, billing, coding, etc.
• Experience with managed care contract terms and federal payer guidelines.
• Experience with medical necessity guidelines and care coordination/case management functions.
• Experience with hospital billing (UB92 form) and coding requirements.
• Understanding of Revenue Cycle Processes.
• In-depth understanding of explanation of benefits (EOBs).
• Effective in identifying and analyzing problems, generating alternatives and identifying possible solutions.
• Timely resolution of claim edits allowing timely claim submission.
• Timely follow-up of unpaid claims, worked to ensure maximum reimbursement following compliant standards.
• Ability to work independently as well as collaboratively within a team environment.
• Excellent problem-solving skills.
• Creative ability to escalation of appeals.
• Excellent verbal, written and customer service communication.
• Strong analytical ability and critical thinking skills required.
• Take initiative.
• Creative problem-solving skills.
• Ability to meet deadlines.
• Personable, tactful and cooperative.
• Ability to work well with others.
• Ability to clearly communicate with and establish and maintain good rapport with peers, physicians, hospital administration, nurses and other healthcare team members required.
• Demonstrate integrity, objectivity, and thinking skills required.
• Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, payor, customers and co-workers.

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.