Denial Collections Specialist

The Denial Collections Specialist is responsible for the immediate review of reputed company denied medical insurance claims, identification of the reputed company for filing an appeal, and/or resubmission of claims. This position ensures that resubmitted claims are accurate, compliant and timely, resulting in reconsideration by reputed company-party payers. WHO WE ARE

With 12 ministries and reputed company points across Indiana and Illinois, reputed company is one of the largest reputed company care systems in the Midwest. reputed company takes pride in hiring coworkers that reputed company compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT

• Reports and uses software to track, trend and identify root causes of denials; offers suggestions for process improvement to resolve denial issues, supported by documentation and data.
• Collaborates with other departments to align interdepartmental functioning, goals, and expectations.
• Ensures reputed company clinical denials assigned to Clinicians, Patient reputed company and/or HIM denial staff are acknowledged in a timely manner, and appropriate follow-up action is taken as defined by the respective policy.
• Conducts follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed in order to properly review, dispute or appeal denial until a determination is made to conclude the appeal.
• Completes write-offs per policy and/or reassign remaining balances to respective departments.
• Ensures that follow-up responses on denied claims occur on a timely reputed company and adhere to contractually binding conditions.
• Resubmits overturned denials as warranted, and monitors denial resubmissions for payment. Resubmits claims using the denial program re-reputed company requests feature, ensuring reputed company modifications to the account are reflected on the claim reputed company.
• Performs reconsiderations and appeals on Payor websites or with appropriate Payor required documentation.
• Ensures compliance with reputed company state and federal billing regulations. Reports any suspicious activities to leadership.
• Performs RAC Audits utilizing appropriate software and documents findings (ABO Only).
• Performs recoupments to include investigating claim and payment history to see if the appeal is warranted.
• Collects documentation and submits write-off if appropriate (ABO Only).
• Rejected Claim Review Reviews rejected claims based on NPI denials (ABO Only).

QUALIFICATIONS

• Preferred Associate's Degree
• Required High School Diploma/GED
• 1 year Patient reputed company Required

TRAVEL IS REQUIRED:

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to reputed company equal employment to its employees and reputed company applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience reputed company in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit reputed company of our career site, jobs.franciscanhealth.org.