Endeavor Health
Healthcare
DenialsManagementSpecialist
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“Denials Management Specialist at Endeavor Health. Skills: Denial management, Patient billing, Managed care. Review denied patient insurance claims. Resolve denied patient insurance claims”
What You'll Achieve.
Decrease future denials
Industry & Context.
Determine accurate denial; Determine process for appeal
What They're Looking For.
Must Have
High School Required, 2 Years previous patient billing, 2 Years managed care experience, Extensive computer knowledge and experience, Knowledge of standard billing guidelines, Knowledge of CPT/ICD9 coding, Knowledge of usual and customary (U& C) schedules
What You'll Do.
Review denied patient insurance claims
Resolve denied patient insurance claims
Gather information for appeal process
Send appeals to insurance companies
Resubmit corrected claim
Submit medical records
Write appeals letters
Provide process improvement recommendations
Identify denial trends
Identify payer issues
Follow up on pending claim denials
Collect data for reports
Send Managed Care Denial Report
How You'll Work.
Team & Collaboration
Works closely with internal departments; Interaction with Physician Practices; Interaction with Providers; Interaction with Payers; Shares findings with stakeholders; Collaborates in the collection of data; Maintains positive working relationships externally; Maintains positive working relationships internally
Communication Scope
Writing appeals letters
Full Job Description
**Hourly Pay Range:** $22.14 - $33.21 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors. **Position Highlights:** * Position: Denial Management Specialist * Location: Warrenville IL * Full Time/Part Time: Full Time * Hours: Monday-Friday, 8am-430pm **A Brief Overview:** 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. **What you will do:** * Reviews and resolves denied patient insurance claims. * Works closely with internal departments in determining accurate denial and process for appeal. Contacts insurance companies/payer or patients to gather information necessary to complete the appeal process. * Sends appeals to insurance companies regarding denials by resubmitting corrected claim, submitting medical records and writing appeals letters in a timely manner * Provides process improvement recommendations to Supervisor to decrease future denials. * Utilizes software tools to identify denial, trends and payer issues. Shares findings with stakeholders. * Follows up on pending claim denials after appeal has been processed -by the insurance company. * Collaborates in the collection of data and sends 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. * Maintains positive working relationships both externally and internally. **What you will need:** * **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 **Benefits (For full time or part time positions):** * Eligibility for our
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