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Denial Management Specialist-Cert CPFSS

4 months ago

Vincennes, United States Good Samaritan Full time
Job Description

Job Summary:

Under the direction of the PB Follow Up & Denial Team Supervisor, the PB Follow Up & Denial Team Member is responsible for monitoring claims for Medicare, Medicaid, Government Payors, Commerical Payors and Work Comp Payors through claim follow up and insurance appeals.

Essential Job Duties:
  1. Researches and analyzes denial data and coordinates denial recovery responsibilities.
  2. Identifies, analyzes, and researches frequent root causes of denials and recommends corrective action plans for resolution of denials.
  3. Prioritizes activities to work overturns in a timely manner to alleviate untimely filings.
  4. Uses WQ sort/filter options to categorize denials to work to overturn denials.
  5. Researches, responds, and documents insurer correspondence /inquiry notes regarding coding, coverage, benefits, and reimbursement on patient accounts timely and accurately.
  6. Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks.
  7. Helps with coverage for Customer Service when needed.
  8. Receive a passing score on the annual competency evaluation.
  9. Demonstrates knowledge of patient confidentiality and HIPAA regulations.
  10. Organized; sets priorities; meets deadlines
  11. Demonstrates knowledge of assigned payor processes for follow up and denials and is able to navigate the payor provider portals easily.
  12. Is a team player and communicates well with others.
  13. Holds certification as a CPFSS (Certified Patient Financial Services Specialist) as well as RHIT or CPC, etc.
  14. Uses sort/filter options to determine priority of working claims in the Follow Up WQ by timely filing deadline and balance.
Secondary Job Duties That May be Reassigned:
  1. Process payor refunds
  2. Answers and directs phone calls
  3. Updates job knowledge by participating in educational opportunities
  4. Complete Wellness Matters adjustments
  5. Print paper claims and document claim run totals
  6. Attach electronic medical records to claims in Waystar


Qualifications

Job Specifications:
  • Education: High School graduate, associate's degree preferred. A coding certification with the following credentials; CCS, CCS-P, RHIT is required.
  • Experience: Insurance knowledge and terminology, understanding of medical terminology, knowledge of CPT, HCPCS and ICD10 coding, knowledge of credentialing workflow, knowledge of medical billing and collection practices, knowledge of working with EHR/EMR, proficient in spelling, grammar, punctuation, and other language skills. Proficient in keyboarding, data entry, and business writing. Practices efficient methods for getting work done; strong ability to prioritize workload. Organized and has the ability to work independently.


About Us

Why Choose Good Samaritan?

For more than 115 years, Good Samaritan has been dedicated to not only providing trusted, industry-leading health care, but to fill a vital role in southwest Indiana and southwest Illinois. Our hospital continues to adhere to the compassionate principles our facility was founded on and further our commitments to our patients, our staff, and the communities we serve. Good Samaritan is well recognized for its commitment to excellence as a 3-time designated Magnet® facility, TJC Primary Stroke Center, and a Level III Trauma Center.

We would love to welcome you to our Good Samaritan family.

About the Team

Thank you for your interest in employment at Good Samaritan Hospital. Please provide all information requested to assure that all your qualifications are fairly considered for current or future vacancies. Your application will remain in our active files for six months. After six months, re-application is necessary. The submission of this application does not automatically result in an employment interview or job offer.

EQUAL EMPLOYMENT OPPORTUNITY POLICY

Good Samaritan Hospital is an equal opportunity employer. It is the policy of this facility to provide equal opportunity to persons regardless of race, religion, age, gender, disability, national origin, color, or any other classification in accordance with federal state and local statements, regulations, and ordinances.