Apply on Employer Site

St. Elizabeth Healthcare · 1 day ago

Specialist Technical Denial

Erlanger, KY

Full-time

Onsite

Mid Level

3+ years exp

St. Elizabeth Healthcare is a trusted provider of quality care across Kentucky, Indiana, and Ohio. The Technical Denials Specialist is responsible for analyzing, resolving, monitoring, and reporting non-clinical denials, ensuring compliance with regulations and improving processes to reduce denials.

Health Care

H1B Sponsor Likely

Responsibilities

Reviews, researches and addresses non-clinical denials

Addresses all accounts assigned to work queue 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

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

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

Qualification

Microsoft OfficeInsurance regulationsMedicare regulationsMedicaid regulationsCertified Revenue Cycle RepresentativeThird Party claim filingContract reimbursementCommunication skillsTeamworkProblem-solving

Required

Associates degree

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

Demonstrates proficiency in Microsoft Office applications and others as required

Demonstrates knowledge and understanding of organizational policies, 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

Benefits

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

Company

St. Elizabeth Healthcare

Glassdoor3.8

St. Elizabeth Healthcare is one of the oldest, largest and most respected medical providers in the Greater Cincinnati region.

Founded in 1861

Kenton, Kentucky, USA

10001+ employees

http://www.stelizabeth.com/

H1B Sponsorship

St. Elizabeth Healthcare 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

2024 (2)

2023 (5)

2022 (1)

2021 (3)