[Hiring] Technical Denial Specialist @St. Elizabeth Healthcare

Role Description

The Technical Denials Specialist is responsible for analyzing, resolving, monitoring, and reporting non-clinical denials to the Denials Unit Manager as appropriate. The role supports the mission, vision, values, and strategies of St. Elizabeth Healthcare.

• Demonstrate respect, dignity, kindness, and empathy in each encounter with all patients, families, visitors, and other employees regardless of cultural background.
• 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 refers to other stakeholders when appropriate.
• Investigates and ensures that questions and requests for information are responded to in a timely and professional manner.
• Performs ongoing monitoring of denials accounts worked to maximize collection dollars.
• Utilizes all appropriate systems to effectively research accounts and complete necessary steps.
• Completes follow-up with patients to obtain additional information as necessary.
• Prepares necessary documentation to submit appeals to payers when payment is denied.
• Completes all necessary outgoing calls and answers incoming calls as appropriate.
• Requests rebilling of accounts as necessary.
• Completes and/or requests adjustments to an account based on adjustment thresholds.
• Reviews, works, and reports all accounts that have aged more than the specified grace period.
• Documents follow-up or patient accounts appropriately.
• Tracks and reports violations of prompt pay/adjudication terms by payers.
• Interfaces with other key internal and external staff to obtain necessary information.
• Reports issues and trends to appropriate management personnel and collaborates 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 and punctuality 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 HIPAA.
• Maintains the privacy and security of all confidential and protected health information.
• Performs other duties as assigned.

Qualifications

• Associates degree OR High School Diploma plus Certified Revenue Cycle Representative and 3 years of related experience.

Requirements

• Demonstrates proficiency in Microsoft Office applications and others as required.
• Demonstrates knowledge and understanding of organizational policies and procedures.
• Knowledge of insurance regulations, payment guidelines, and policies.
• 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.