Denial Collections Specialist

The Denial Collections Specialist is responsible for the immediate review of all denied medical insurance claims, identification of the basis for filing an appeal, and/or resubmission of claims. This position ensures that resubmitted claims are accurate, compliant and timely, resulting in reconsideration by third-party payers. WHO WE ARE

With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve. WHAT YOU CAN EXPECT

• Reports and uses software to track, trend and identify root causes of denials; offers suggestions for process improvement to resolve denial issues, supported by documentation and data.
• Collaborates with other departments to align interdepartmental functioning, goals, and expectations.
• Ensures 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.
• Conducts 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.
• Completes write-offs per policy and/or reassign remaining balances to respective departments.
• Ensures that follow-up responses on denied claims occur on a timely basis and adhere to contractually binding conditions.
• Resubmits overturned denials as warranted, and monitors denial resubmissions for payment. Resubmits claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form.
• Performs reconsiderations and appeals on Payor websites or with appropriate Payor required documentation.
• Ensures compliance with all state and federal billing regulations. Reports any suspicious activities to leadership.
• Performs RAC Audits utilizing appropriate software and documents findings (ABO Only).
• Performs recoupments to include investigating claim and payment history to see if the appeal is warranted.
• Collects documentation and submits write-off if appropriate (ABO Only).
• Rejected Claim Review Reviews rejected claims based on NPI denials (ABO Only).

QUALIFICATIONS

• Preferred Associate's Degree
• Required High School Diploma/GED
• 1 year Patient Accounting Required

TRAVEL IS REQUIRED:

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.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.