at NorthShore University Health System in Warrenville, Illinois, United States
Job Description
Position Highlights:
Position: Managed Care Denial Specialist
Location: Warrenville, IL
Full Time/Part Time: Full Time
Hours: Monday-Friday, 8am-4:30pm
A Brief Overview:
Under general direction of the Patient Accounts Manager, reviews managed care denials which pertain to medical necessity, pre-certification, authorization and level of care requirements. This involves interaction with Managed Care Financial Counselors, Insurance Verifiers, Utilization Review and insurance companies.
What you will do:
Receives denial of claim through cash posting information, managed care financial counselor, managed care software tool (Concuity) and/or utilization review department.
Works closely with utilization review department in determining accurate denial and process for appeal.
Sends appeals to insurance companies regarding denials for pre-certification and authorization after determination of inaccurate payer decision.
Provides process improvement recommendations to Manager to decrease future denials.
Utilizes software tool to identify denial, trends and payer issues.
Follows up on pending claim denials after appeal has been processed to the insurance company.
Develops and sends monthly "Managed Care Denial Report" to appropriate departments such as, but not limited to: Patient Accounts Manager; Director, Patient Accounts; Manager, Managed Care Contracting and Utilization Review.
Maintains a positive working relationship both externally and internally.
Performs other duties as assigned by Patient Accounts management
What you will need:
High School Required
2 Years previous patient billing and/or managed care experience
extensive computer knowledge and experience and possess knowledge of standard billing guidelines, CPT/ICD9 coding, usual and customary (U& C) schedules
Benefits:
Career Pathways to Promote Professional Growth and Development
Various Medical, Dental, Pet and Vision options
Tuition Reimbursement
Free Parking
Wellness Program Savings Plan
Health Savings Account Options
Retirement Options with Company Match
Paid Time Off and Holiday Pay
Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals - Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) - all recognized as Magnet hospitals for nursing excellence. For more information, visit www.endeavorhealth.org.
When you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.
Please explore our website (www.endeavorhealth.org) to better understand how Endeavor Health delivers on its mission to "help everyone in our communities be their best".
Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.
Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
