Denials Management Specialist

Position Highlights

• Position:
  Denial Management Specialist
• Location:
  
  Warrenville, IL
• Full Time/Part Time:
  Full Time
• Hours:
  
  Monday-Friday, 8am-4:30pm

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.

• Review and resolve denied patient insurance claims.
• Work closely with internal departments to determine accurate denial and process for appeal. Contact insurance companies/payers or patients to gather information necessary to complete the appeal process.
• Send appeals to insurance companies regarding denials by resubmitting corrected claim, submitting medical records and writing appeals letters in a timely manner.
• Provide process improvement recommendations to Supervisor to decrease future denials.
• Utilize software tools to identify denial, trends and payer issues. Share findings with stakeholders.
• Follow up on pending claim denials after appeal has been processed by the insurance company.
• Collaborate in the collection of data and send 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.
• Maintain positive working relationships both externally and internally.

• 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.

• Career Pathways to Promote Professional Growth and Development
• Various Medical, Dental, and Vision options
• Tuition Reimbursement
• Free Parking at designated locations
• 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. 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.

EOE:
Race/Color/Sex/Sexual Orientation/Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.