Kettering Health · 1 month ago
Patient Accounts Denial Specialist-Patient Financial Services
2110 Leiter Road
Full-time
Onsite
Entry Level
1+ years expKettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. They are seeking a Patient Accounts Denial Specialist who will be responsible for identifying and analyzing denial causes, developing corrective action plans, and ensuring timely resolution of claims while maintaining communication with insurance payers.
FitnessHealth CareHospitalMedical
Responsibilities
Identifying, analyzing, and researching frequent root causes of denials and develop corrective action plans for resolution of denials
Position will be required to be detailed oriented and formulated appeals researching and analyzing denial data and coordinating denial recovery responsibilities
Candidate will be required to be knowledgeable, understand, and apply critical thinking skills to the correct appeal methodology to help address various denials such as proving medical necessity and retro authorizations appeals
Specialist are required to apply the proper escalation of outstanding denials including submitting complaints to various agencies such as the Ohio Department of Medicaid and the Department of Insurance
In additional to denials, employee will address pre and post takebacks by health plans that are required to be investigated and appropriate action taken
Specialist must prioritize activities to work overturns in a timely manner to alleviate untimely filings is a must
Working with Insurance payers to ensure proper billing takes place on all assigned patient accounts
Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report to expedite resolution of accounts
Works follow up report daily, maintaining established goal(s), and notifies Team Lead and/or Supervisor, of issues preventing achievement of such goal(s)
Follows up on daily correspondence to appropriately work patient accounts
Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved
Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc
Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers, or employers, as appropriate
Sends initial or secondary bills to Insurance payers
Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts
Escalation to Supervisor/Manager of any issues or changes in billing system, insurance carrier, and/or networks
Works other duties as assigned
Writing appeals on denials including pre and post takebacks
Contacting payer to acquire status of submitted appeal
Joining payer calls and participating to address issues
Qualification
Required
High school Diploma or equivalent required
Minimum of a year working denials in the healthcare setting
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 (EOB's)
Effective in identifying and analyzing problems. Generates alternatives and identifies 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 skills
Strong analytical ability and critical thinking skills required
Takes 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
Preferred
Epic EMR Experience
Relay Health/ePremis Experience
Company
Kettering Health
Kettering Health is a healthcare company that provides faith-based community care to patients.
10001+ employees
H1B Sponsorship
Kettering Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2021 (1)
Funding
Current Stage
Late StageTotal Funding
$1.39MKey Investors
SAMHSAParkinson's Foundation
2024-10-11Grant· $1.39M
2023-07-25Grant
Leadership Team
Fred Manchur
Chief Executive Officer
Clifton Patten
CFO
Recent News
2025-10-12
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