Specialist Technical Denial
2 weeks ago
Engage with us for your next career opportunity. Right Here.
Job Type:
RegularScheduled Hours:
40Job Summary:
The Technical Denials Specialist is responsible for analyzing, resolving, monitoring and reporting non-clinical denials to Denials Unit Manager as appropriate. The Technical Denial Specialist is responsible for follow-up and resolutions for denials escalated through a work queue, providing appropriate denial information to be submitted to departments to ensure systems, processes and measures of effectiveness (e.g. Remediation action plans) are created and implemented to resolve root cause issues and reduce/ eliminate denials. The Technical Denial Specialist should remain in full compliance with all departmental, institutional and regulatory policies and procedures at all times. The roles and responsibilities of this job support 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.
Job Description:
- 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 referrals to other stakeholders, when appropriate.
- Investigates and/or ensures that questions and requests for information are responded to in a timely and professional manner to ensure resolution of outstanding accounts.
- Performs ongoing monitoring of denials accounts worked, as necessary, to ensure maximization of collection dollars by providing appropriate follow-up and documenting actions taken.
- Utilizes all appropriate systems to effectively research accounts and complete steps to submit information necessary to process or appeal accounts.
- Completes follow-up with patients, as necessary, to obtain additional information.
- Prepares necessary documentation to submit appeals to payers when payment is denied.
- Complete all necessary outgoing calls and answer incoming calls, as appropriate.
- Make revisions or changes to insurance information, as appropriate.
- Requests the rebilling accounts as necessary.
- Complete and/or request adjustments to an account, as appropriate, based on adjustment thresholds.
- Reviews, works and reports (with accuracy) all accounts that have aged more than the specified grace period stipulated in the policies and/or contracts.
- Documents follow-up or patient accounts appropriately.
- Tracks and reports violation of prompt pay/adjudication terms by payers and follows up proactively with payers to provide necessary additional documentation for patient accounts that have been reviewed by payers and awaiting documentation to determine adjudication
- Interfaces with other key internal and external staff to obtain necessary information to address payment variance management issues or requests.
- Reports issues and trends to appropriate management personnel and works collaboratively to develop solutions.
- Reports issues and trends to appropriate management personnel and works collaboratively 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 record and punctuality record 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 HIPPA.
- Maintains the privacy and security of all confidential and protected health information; job duties warrant a “high” level of computer system access (all necessary areas) to patient information ONLY for those job functions as outlined in this job description; uses and discloses only that information which is necessary to perform the function of the job.
- Performs other duties as assigned.
Education, Credentials, Licenses:
- Associates degree
OR
- High School Diploma plus Certified Revenue Cycle Representative and 3 years of related experience.
Specialized Knowledge:
- Demonstrates proficiency in Microsoft Office applications and others as required
- Demonstrates knowledge and understanding of organizational policies, procedures
- Knowledge of insurance regulations, payment guidelines and policies and the ability to communicate and work with payors to get accounts resolved and paid accurately
- Extensive knowledge of Medicare and Medicaid regulations
- Knowledge of third Party claim filing, contract reimbursement and other insurance guidelines
FLSA Status:
Non-ExemptRight Career. Right Here. If you're looking for the right careers in healthcare, the right place to be is at St. Elizabeth. Join us, and you'll take pride in the level of care we offer our community.
-
Specialist Technical Denial
2 weeks ago
Erlanger, United States St. Elizabeth Healthcare Full timeEngage with us for your next career opportunity. Right Here.Job Type:RegularScheduled Hours: 40Job Summary:The Technical Denials Specialist is responsible for analyzing, resolving, monitoring and reporting non-clinical denials to Denials Unit Manager as appropriate. The Technical Denial Specialist is responsible for follow-up and resolutions for denials...
-
Specialist Technical Denial
2 weeks ago
Erlanger, United States St. Elizabeth Healthcare Full timeEngage with us for your next career opportunity. Right Here.Job Type:RegularScheduled Hours: 40Job Summary:The Technical Denials Specialist is responsible for analyzing, resolving, monitoring and reporting non-clinical denials to Denials Unit Manager as appropriate. The Technical Denial Specialist is responsible for follow-up and resolutions for denials...
-
Senior Aircraft Maintenance Controller
2 days ago
Erlanger, Kentucky, United States STS Technical Services Full timeJob Summary:We are seeking a highly skilled Aircraft Maintenance Controller to join our team at STS Technical Services. As a key member of our maintenance operations team, you will be responsible for ensuring the safe and efficient maintenance of our aircraft fleet.Key Responsibilities:Coordinate Maintenance Activities: Work closely with our vendors and...
-
Aircraft Maintenance Specialist
2 days ago
Erlanger, Kentucky, United States FEAM Full timeJob Type: Full-time Position Overview:FEAM Aero is recognized as a leader in the maintenance, repair, and overhaul (MRO) sector for aircraft line services across the United States. Our organization excels in providing comprehensive aircraft repair solutions, supported by an extensive network of line stations and approvals for a wide range of aircraft,...
-
Sensory Specialist
4 weeks ago
Erlanger, United States ADM Full timeJob Description PGCS (Pepsico Global Concentrate solutions) Sensory Specialist - Erlanger, KYThis is a full-time, exempt position.Job Summary: The PGCS- Pepsico Global Concentrate solutions Sensory Specialist role is a North America technical execution position that is responsible to ensure all PGCS related materials meet PGCS sensory specification prior to...
-
Commercial Quality Specialist
4 weeks ago
Erlanger, United States ADM Full timeJob Description Commercial Quality Specialist - Erlanger, KYJob Summary: The Commercial Quality Specialist is a technical position within the Quality organization, and reports tothe Key Account Commercial Quality Manager for Flavors North America. This role will provide technical support and leadership for various project initiatives and process improvements...
-
Regulatory Compliance Specialist
15 hours ago
Erlanger, Kentucky, United States ADM Full timeJob Description**Regulatory Specialist Role**The Regulatory Specialist will provide regulatory expertise to support the overall business strategy of ADM, both internally and externally. This involves regular communication with various stakeholders, including R&D, logistics, sales, vendors, and customers, to support business growth and productivity.Main...
-
Senior Powerplant Engineering Specialist
2 weeks ago
Erlanger, Kentucky, United States Atlas Air Full timeSenior Powerplant Engineering SpecialistJob OverviewThe Senior Powerplant Engineer plays a crucial role in ensuring the safety, airworthiness, and operational reliability of aircraft at Atlas Air. Reporting directly to the Powerplant Engineering Manager, this position involves overseeing engineering data, documentation, and technical support across various...
-
Regulatory Compliance Specialist
3 days ago
Erlanger, Kentucky, United States ADM Full timeJob DescriptionJob Title: Associate Regulatory SpecialistJob Summary:This entry-level role will maintain raw material documentation and the raw material data in internal databases, along with learning and applying key concepts in the regulatory space.The role will gain experience in evaluating raw materials against FDA and other regulatory agency frameworks,...
-
Regulatory Specialists
4 weeks ago
Erlanger, United States ADM Full timeJob Description Regulatory Specialist - Any ADM OfficeMAIN FUNCTION:The specialist role provides Regulatory know-how and expertise to support the overall business strategy of the organization, both internally and externally. It involves regular verbal and electronic communication with R&D, logistics, sales, vendors and customers to support the growth and...
-
Lead IT Risk Assurance Specialist
2 weeks ago
Erlanger, Kentucky, United States Insight Global Full timeInsight Global is in search of a Lead IT Risk Assurance Specialist who will work remotely in a contract capacity with potential for permanent placement in the future. The Lead Risk Assurance Specialist will be responsible for evaluating risks and controls associated with information systems within the organization’s Global Technology sector. Key...
-
Infrastructure Systems Specialist
2 weeks ago
Erlanger, Kentucky, United States ANSWERS IN GENESIS GROUP Full timeJob OverviewPosition SummaryThe IT division at Answers in Genesis is actively seeking an Infrastructure Systems Specialist to deliver comprehensive support for server, storage, and backup/recovery systems across the organization. This role is pivotal in enhancing and maintaining server and systems connectivity, ensuring optimal functionality, and managing...
-
Regulatory Specialists
7 days ago
Erlanger, United States Archer Daniels Midland Company (ADM) Full timeRegulatory Specialist - Any ADM OfficeMAIN FUNCTION:The specialist role provides Regulatory know-how and expertise to support the overall business strategy of the organization, both internally and externally. It involves regular verbal and electronic communication with R&D, logistics, sales, vendors and customers to support the growth and productivity of the...
-
Associate Regulatory Specialist
4 weeks ago
Erlanger, United States ADM Full timeJob Description Associate Regulatory Specialist - Erlanger, KYMAIN FUNCTION:This entry level role will maintain raw material documentation and the raw material data in internal databases, along with learning and applying key concepts in the regulatory space. The role will gain experience in evaluating raw materials against FDA and other regulatory agency...
-
E-Discovery Specialist
1 month ago
Erlanger, Kentucky, United States Archer Daniels Midland Company (ADM) Full timeE-Discovery Specialist - Erlanger, KYADM is looking for a E-Discovery Specialist to work with our Legal and E-Discovery IT teams. This role will report to the Chief Counsel, Litigation & Regulatory Law within Legal at ADM. All candidates should have experience dealing with complex customer requirements and servicing them.The E-Discovery Specialist will...
-
E-Discovery Specialist
4 weeks ago
Erlanger, United States ADM Full timeJob Description E-Discovery Specialist - Erlanger, KYADM is looking for a E-Discovery Specialist to work with our Legal and E-Discovery IT teams. This role will report to the Chief Counsel, Litigation & Regulatory Law within Legal at ADM. All candidates should have experience dealing with complex customer requirements and servicing them.The E-Discovery...
-
Safety Services Specialist
4 weeks ago
Erlanger, United States Fortress Safety Full timeJob Title: Fortress Safety Services Specialist Looking to use your training skills to grow capability in a wide range of customers while working for a quickly growing company?Location: Fortress Safety America, Erlanger, KYType: Full-timeReporting To: Vice President of Technical SafetyIntroducing FortressAt Fortress we strive to only do things which “save...
-
Safety Services Specialist
4 weeks ago
Erlanger, United States Fortress Safety Full timeJob Title: Fortress Safety Services Specialist Looking to use your training skills to grow capability in a wide range of customers while working for a quickly growing company?Location: Fortress Safety America, Erlanger, KYType: Full-timeReporting To: Vice President of Technical SafetyIntroducing FortressAt Fortress we strive to only do things which “save...
-
Sensory Quality Assurance Specialist
16 hours ago
Erlanger, Kentucky, United States ADM Full timeJob DescriptionJob Title: Sensory Quality Assurance SpecialistJob Summary:This is a full-time, non-exempt position that provides sensory support for the laboratory, implementing training for other technicians and driving organoleptic accuracy. The occupant of this role will track and trend data to confirm technicians are properly performing sensory analysis,...
-
Regulatory Specialists
2 weeks ago
Erlanger, United States Archer Daniels Midland Company Full timeJob DescriptionRegulatory Specialist - Any ADM OfficeMAIN FUNCTION: The specialist role provides Regulatory know-how and expertise to support the overall business strategy of the organization, both internally and externally. It involves regular verbal and electronic communication with R&D, logistics, sales, vendors and customers to support the growth and...