close
HospitalRecruiting.com Login
Reset Your Password

New to HospitalRecruiting.com?

With HospitalRecruiting.com you can browse and apply to jobs across the country, track your job leads, email directly to employers, & more!

Next Steps...
By clicking "Apply Now" you will be redirected to the employer's webpage to complete the application.
Register Now
Franciscan Health Physician Jobs

Billing and Insurance Specialist Job In Dyer, Indiana

Clinical Denial Specialist

Next Steps...
By clicking "Apply Now" you will be redirected to the employer's webpage to complete the application.
Register Now
Company: Franciscan Health Profession/Specialty: Billing and Insurance Specialist Location: Dyer, Indiana 46311 Type of Facility: Hospital
Job Description

Clinical Denials | Franciscan Alliance

24 Joliet Street
Dyer,IN46311

Part-Time Not Benefit eligible

High School Diploma/ GED Required

Days

WHAT WE NEED

A persistent person who can find the answers

WHO WE ARE LOOKING FOR

High quality health care is both a calling and a business. And the business side dictates reviewing clinically denied cases, determining if appeals can be made, and providing follow-up. Bottom line: this job is important for back-end operations. Think you’re up for the job?

 

Are you timely and accurate? Are you detail-oriented? Do you love knowing that you’re an integral part of the team? We’ve got a great place to put your skills to work.

WHAT YOU WILL DO

  • Provide feedback to appropriate staff/departments and facilitates performance improvement regarding denials resolution and prevention.
  • Denials management, including reviewing clinically denied cases and prioritize cases to determine if appeal can be made within filing timeframe, as well as pre-certification issues for submitting  appropriate appeals, providing appeal follow-up and completes monthly reporting.
  • Collaborate with case managers in contacting the physician/office staff to obtain further patient information for medical necessity to be used in the appeals process.
  • Collaborate with Division Director on complicated cases to determine if further medical necessity can be established.
  • Perform medical record audits for comparison with third party audits and resolution of patient billing disputes.
  • Perform additional medical record reviews and follow-up as requested.
  • Act as a resource person for inter/intradepartmental personnel as they relate to issues of medical necessity, payor contract interpretation and rules and regulations related to reimbursement.
  • Establish methods of data collection and provide reports.
  • Maintain a database of cases needing appeal, those that are pending, overturned or upheld in order to assure cases are being addressed and within the appropriate timeframe.
  • Attend and participate in house-wide multi-disciplinary committees as pertains to denial management.
  • Participate with corporate administration, corporate case management and AIS for standardization and implementation of corporate-wide computer systems, i.e. Denials Management and Case Management.
  • Coordinate, schedule, and collaborate with AIS in implementing software and hardware  updates and upgrades related to denial management.
  • Define educational needs; develop and facilitate ongoing training for new and existing  computer system users and Case Management department personnel related to denials software.
  • Provide first-line assistance for Case Management system users and coordinate communication with AIS for problem resolution.
WHAT IT TAKES TO SUCCEED

  • Strong analytical skills to collect, analyze, and interpret data.
  • Organizational and prioritizing skills.
  • Strong communication skills, both verbal and written.
  • Knowledge of Denials Management and Case Management computer systems.
  • Maintain current knowledge base for regulations: state, federal, and commercial payors.


WHAT WE'RE LOOKING FOR

3-5 Years Experience

License(s):

Certification(s):


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.

EOE
Next Steps...
By clicking "Apply Now" you will be redirected to the employer's webpage to complete the application.
Register Now
Franciscan Health Physician Jobs
About Franciscan Health

Answer your calling to help, to heal and to give compassionate care. We offer a wide variety of professional and medical careers with excellent benefits. Explore your opportunities with Franciscan Health.

Contact Information
By clicking "Apply Now" you will be redirected to the employer's webpage to complete the application.
Get notified by email when similar jobs are posted

You can cancel email alerts at any time.