Kettering Health
Patient Accounts Denial Specialist-Patient Financial Services
Kettering Health, Miamisburg, Ohio, us, 45343
Patient Accounts Denial Specialist-Patient Financial Services
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Job Details
System Services | Miamisburg | Full-Time | First Shift
Responsibilities
Identify, analyze, and research frequent root causes of denials and develop corrective action plans for resolution of denials.
Formulate appeals, research and analyze denial data, and coordinate denial recovery responsibilities.
Apply critical thinking skills to correct appeal methodology to address various denials such as proving medical necessity and retro authorizations appeals.
Escalate outstanding denials, including submitting complaints to agencies such as the Ohio Department of Medicaid and the Department of Insurance.
Investigate and appropriately address pre- and post-takebacks by health plans.
Prioritize activities to work overturns in a timely manner to alleviate untimely filings.
Work with insurance payers to ensure proper billing on all assigned patient accounts.
Participate in conference calls, accounts receivable reports, compile issue reports to expedite resolution of accounts.
Follow up daily reports, maintain established goals, and notify Team Lead and/or Supervisor of issues preventing achievement of such goals.
Assist Customer Service with patient concerns/questions to ensure prompt and accurate resolution.
Produce written correspondence to payers and patients regarding status of claim, requesting additional information, etc.
Initiate next billing, assign appropriate follow-up and/or collection steps, including calling patients, insurers, or employers as appropriate.
Send initial or secondary bills to insurance payers, documenting billing, follow-up and/or collection steps taken and all measures to resolve assigned accounts.
Escalate to Supervisor/Manager any issues or changes in billing system, insurance carrier, and/or networks.
Write appeals on denials including pre- and post-takebacks; contact payer to acquire status of submitted appeal; join payer calls and participate to address issues.
Requirements
High school Diploma or equivalent required.
Minimum of a year working denials in the healthcare setting.
Experience in Microsoft tools, Epic EMR Experience (preferred), Relay Health/ePremis Experience (preferred).
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 (EOBs).
Effective in identifying and analyzing problems, generating alternatives and identifying 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.
Strong analytical ability and critical thinking skills required.
Take 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.
Overview Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
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Job Details
System Services | Miamisburg | Full-Time | First Shift
Responsibilities
Identify, analyze, and research frequent root causes of denials and develop corrective action plans for resolution of denials.
Formulate appeals, research and analyze denial data, and coordinate denial recovery responsibilities.
Apply critical thinking skills to correct appeal methodology to address various denials such as proving medical necessity and retro authorizations appeals.
Escalate outstanding denials, including submitting complaints to agencies such as the Ohio Department of Medicaid and the Department of Insurance.
Investigate and appropriately address pre- and post-takebacks by health plans.
Prioritize activities to work overturns in a timely manner to alleviate untimely filings.
Work with insurance payers to ensure proper billing on all assigned patient accounts.
Participate in conference calls, accounts receivable reports, compile issue reports to expedite resolution of accounts.
Follow up daily reports, maintain established goals, and notify Team Lead and/or Supervisor of issues preventing achievement of such goals.
Assist Customer Service with patient concerns/questions to ensure prompt and accurate resolution.
Produce written correspondence to payers and patients regarding status of claim, requesting additional information, etc.
Initiate next billing, assign appropriate follow-up and/or collection steps, including calling patients, insurers, or employers as appropriate.
Send initial or secondary bills to insurance payers, documenting billing, follow-up and/or collection steps taken and all measures to resolve assigned accounts.
Escalate to Supervisor/Manager any issues or changes in billing system, insurance carrier, and/or networks.
Write appeals on denials including pre- and post-takebacks; contact payer to acquire status of submitted appeal; join payer calls and participate to address issues.
Requirements
High school Diploma or equivalent required.
Minimum of a year working denials in the healthcare setting.
Experience in Microsoft tools, Epic EMR Experience (preferred), Relay Health/ePremis Experience (preferred).
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 (EOBs).
Effective in identifying and analyzing problems, generating alternatives and identifying 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.
Strong analytical ability and critical thinking skills required.
Take 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.
Overview Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.
#J-18808-Ljbffr