PFS Denial Specialist, Full Time - Days - job 1 of 2

Job Description

Join Ingalls Memorial Hospital as a Patient Financial Services Denial Specialist. Here, you will join our Revenue Cycle team at our Burr Ridge location. This position will be primarily a work from home opportunity with the requirement to come onsite as needed. You may be based outside of the greater Chicagoland area.

Under general direction, the Patient Financial Services Denial Specialist is responsible for reviewing denied claims and carrying out the appeals process for Ingalls Memorial Hospital.  This position works to maintain third-party payer relationships, including responding to inquiries, complaints, and other correspondence, and possibly setting up arbitration between parties.  The denial analyst has a working knowledge of state/federal laws that relate to contacts and to the appeals process.  Maintains and monitors integrity of the claim development and submission process. 

Essential Job Functions

• Executes the denial appeals process, which includes receiving, assessing, documenting, tracking, responding to and/or resolving appeals with third-party payers in a timely manner.  Regularly makes complex decisions within the scope of the position, and is comfortable working independently
• Works closely with insurance and managed care companies to ensure proper review and processing of denied claims
• Acts as a liaison between insurance companies and physicians to provide medical necessity for denied claims
• Identifies and tracks payer denials trends and works with the payers to correct any erroneous denials and works with the departments to review and improve processes to avoid these denials in the future
• Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms
• Maintains data on the types of claims denied and root causes of denials, and collaborates with team members to make recommendations for improvements and resolving issues
• Contacts patients to communicate insurance coverage denials and works with the patient to overturn the denials related to patient information needed
• Works closely with Denial Manager to provide key information for the Denial Task Force Meetings.  Complies with State and Federal regulations, accreditation/compliance requirements, and Ingalls Memorial Hospital policies, including those regarding fraud and abuse, confidentiality, and HIPAA.  Maintains current knowledge of rules and regulations of third party payers.  Performs related duties as required

Required Qualifications 

• High school diploma or equivalent
• Minimum 3 years of experience in healthcare billing, collections, payment processing, or denials management (Denial Management experience preferred).
• Minimum 3 years of experience using computer programs for tracking denials and appeals
• Demonstrated knowledge of: Hospital billing and reimbursement, Medicare and Medicaid denials and appeals, third-party contracts, NCQA guidelines for denials and appeals, federal and state regulations relating to denials and appeals, proven critical thinking and analytical skills, proficient organizational skills and attention to detail, strong writing and communication skills, high level of comfort with computer systems

Position Details

• Job Type: Full Time (1.0 FTE) 
• Shift: Days
• Work Location: Flexible Remote – Burr Ridge
• Department: Revenue Cycle
• CBA Code: Non-Union 

Why Join Us

For nearly a century Ingalls Memorial has pioneered sophisticated clinical care and developed the area's most convenient network of comprehensive outpatient centers, all dedicated to improving the health and wellbeing of the community. Now, partnered with UChicago Medicine, we have expanded our network of expert physicians, convenient facilities and scope of service to speed your healing process and help navigate your path to wellness. A skilled Medical Staff and talented employees dedicated to prevention, diagnosis, treatment and rehabilitation of illness and injury provide a firm foundation for our reputation for quality.

To accomplish this, we need employees with passion, talent and commitment… with patients and with each other. We’re in this together: working to advance medical innovation, serve the health needs of the community, and move our collective knowledge forward. If you’d like to add enriching human life to your profile, UChicago Medicine Ingalls Memorial is for you. Here at Ingalls, we’re doing work that really matters. Join us!

UChicago Medicine Ingalls Memorial is growing; discover how you can be a part of this pursuit of excellence at: Ingalls Career Opportunities

UChicago Medicine Ingalls is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, ethnicity, ancestry, sex, sexual orientation, gender identity, marital status, civil union status, parental status, religion, national origin, age, disability, veteran status and other legally protected characteristics.

Must comply with Ingalls Memorial Hospital's COVID-19 Vaccination requirement as a condition of employment. If you have already received the vaccination, you must provide proof as part of the pre-employment process. This is in addition to your compliance with the Flu Vaccination requirement as well. Medical and religious exemptions will be considered consistent with applicable law. Lastly, a pre-employment physical, drug screening, and background check are also required for all employees prior to hire.

Compensation & Benefits Overview

UChicago Medicine is committed to transparency in compensation and benefits. The pay range provided reflects the anticipated wage or salary reasonably expected to be offered for the position.

The pay range is based on a full-time equivalent (1.0 FTE) and is reflective of current market data, reviewed on an annual basis. Compensation offered at the time of hire will vary based on candidate qualifications and experience and organizational considerations, such as internal equity. Pay ranges for employees subject to Collective Bargaining Agreements are negotiated by the medical center and their respective union. Review the full complement of benefit options for eligible roles at Benefits - UChicago Medicine.