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Denial Collections Specialist

Company: Francisan Health
Location: Greenwood
Posted on: May 1, 2021

Job Description:

WHAT WE NEED Persistent, organized financial support WHO WE ARE LOOKING FOR Some people love getting to the bottom of things -- chasing down claims, resolving accounts, digging through the details to identify discrepancies and needs. Yes, we're talking about people who love collections. And it takes a love of getting into the details to do this job well. Do you have top notch customer service and data entry skills? Are you good at following through on inquiries? Are you accurate and organized? We'd love to talk to you about working here. WHAT YOU WILL DO

  • Analyze reports and use software to track, trend and identify root causes of denials; offer suggestions for process improvement to resolve denial issues, supported by documentation and data.
  • Collaborate with other departments to align interdepartmental functioning, goals, and expectations.
  • Ensure all clinical denials assigned to Clinicians, Patient Access and/or HIM denial staff are acknowledged in a timely manner and appropriate follow-up action is taken as defined by the respective policy.
  • Conduct 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.
  • Ensure that follow-up responses on denied claims occur on a timely basis and adhere to contractually binding conditions.
  • Resubmit overturned denials as warranted and monitor denial resubmissions for payment; resubmit claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form.
  • Ensure compliance with all state and federal billing regulations.
  • Perform recoupments to include investigating claim and payment history to see if the appeal is warranted.
  • Review rejected claims based on NPI denials. WHAT IT TAKES TO SUCCEED
    • Prior Patient Accounting experience.
    • Understanding of billing and collection systems.
    • Customer service skills.
    • Adapt to high volume and high stress areas.
    • Concentrate for long periods.
    • Critical thinking skills.
    • Critically evaluate and analyze information.
    • Effectively communicate verbally and in writing.
    • Knowledge of HIPAA Guidelines.
    • Maintain a positive approach, work cooperatively with others, and demonstrate a constructive response to criticism.
    • Knowledge of Managed Care requirements under the Medicare/Medicaid and other third party payor programs.
    • Proficient in Microsoft Office Applications. EQUAL OPPORTUNITY EMPLOYER It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection 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.

Keywords: Francisan Health, Greenwood , Denial Collections Specialist, Accounting, Auditing , Greenwood, Indiana

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