Specialist Technical Denial

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Job Type:

Regular

Scheduled Hours:

40

Why Youll Love Working with St. Elizabeth Healthcare

At St. Elizabeth 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. Were 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:

St. Elizabeth is hiring a Technical Denials Specialist! This position is remote after an initial training period and will be full-time dayshift.

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 reviews and resolves technical denials received post service 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 queues 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 including escalation through payer joint operating calls.
• 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 appropriate management personnel and works collaboratively to develop solutions.
• Reports issues and trends to appropriate management personnel and works collaboratively to develop solutions.
• Facilitate joint operating calls for assigned payer with the support of department leadership in addition to managing plan spreadsheets coordinating meeting times submitting meeting agenda and ensuring any information requested by the plans provider representative is delivered in a timely manner.
• 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 record and punctuality record 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 federal state and local regulations and HIPPA.
• Maintains the privacy and security of all confidential and protected health information; job duties warrant a high level of computer system access (all necessary areas) to patient information ONLY for those job functions as outlined in this job description; uses and discloses only that information which is necessary to perform the function of the job.
• Performs other duties as assigned.

Education Credentials Licenses:

• Associates degree

OR

• High School Diploma plus Certified Revenue Cycle Representative and 3 years of related experience.

Specialized Knowledge:

• Demonstrates proficiency in Microsoft Office applications and others as required
• Demonstrates knowledge and understanding of organizational policies and procedures
• Knowledge of insurance regulations payment guidelines and policies and the ability to communicate and work with payors to get accounts resolved and paid accurately
• Extensive knowledge of Medicare and Medicaid regulations
• Knowledge of third Party claim filing contract reimbursement and other insurance guidelines

Kind and Length of Experience:

3 years experience including customer service etiquette and interaction with internal and external.

FLSA Status:

Non-Exempt

Right Career. Right Here. If youre looking for the right careers in healthcare the right place to be is at St. Elizabeth. Join us and youll take pride in the level of care we offer our community.