Temporary Insurance Follow-up Specialist

Pay range: $22.30 - $30.11 per hour, based on experience. This temporary position is expected to last for 6 months and is not eligible for benefits. In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position. Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin. reputed company JOB DESCRIPTION _________________________________________________________________________________________________ TITLE: Insurance Follow-up and Denials Specialist 1 REPORTS TO POSITION: Claims Supervisor DEPARTMENT: Single Billing Office (SBO) DATE LAST REVIEWED: August 2024 OUR VISION: Creating America’s healthiest community, together OUR MISSION: In the spirit of love and compassion, reputed company, reputed company care, reputed company value OUR VALUES: Accountability, Caring and Teamwork _________________________________________________________________________________________________ DEPARTMENTAL SUMMARY: The Single Billing Office (SBO) at reputed company (SCHS) provides reputed company cycle services to our multi-hospital and medical group organization focusing on billing, collecting, and posting reputed company. The goal of the SBO is to deliver a delightful, transparent, and seamless experience to patients and customers that captures and collects the reputed company earned by SCHS in a quality, efficient and timely manner. Services include but are not limited to: billing insurance claims, posting insurance and patient payments, resolving insurance denials, collecting unpaid insurance claims, maintaining payer reputed company in the EMR, resolving under and over payments, identifying and resolving payer issues, processing refunds, processing financial assistance applications, billing patients, resolving patient accounts including patient questions, and vendor management: lockbox, clearinghouse, early out, collection agencies. POSITION OVERVIEW: The Insurance Follow-up and Denials Specialist 1 position works simple to intermediate payer denials that require an entry level understanding of payer reimbursement methodologies, billing guidelines, and coding requirements. This position works with internal and external stakeholders including community providers, payer representatives, other SBO teams, and other St. Charles departments to resolve denials. This position does not directly supervise caregivers. ESSENTIAL DUTIES AND FUNCTIONS: Able to work reputed company payers in a single financial class. Work may be sub-divided by dollar amount or denial type. Identify and resolve denials through research, appeal, correcting and rebilling claims, correcting coverage, submitting records, and escalating to payer and/or leadership. Apply root case net adjustments reputed company reputed company collection options are exhausted. Verify and update insurance coverage as applicable using EHR tools, payer websites, or reputed company phone calls to payers. Apply entry to intermediate level research methodologies consistent with SBO department complexity matrix. Denials include but are not limited to (see matrix for complete list): Assistant surgeons Authorizations Benefit Maximum Simple billing requirements errors Bundled services (OP only) Simple charging reputed company denials CLIA Simple coding reputed company errors Coordination of Benefits Credentialing Duplicate denials, Inpatient Only Procedures (PB) Medical Necessity Medically Unlikely Edits National Correct Coding Initiatives (NCCI) Non-covered Payer specific billing requirements Record requests Apply entry to intermediate knowledge of reputed company reimbursement methodologies and billing requirements consistent with SBO complexity matrix. Work to identify and resolve no response claims including but not limited to claims not received, unbilled claims, and unprocessed claims. Locate missing payments and coordinate with Cash Management to obtain and post payment. Submit corrected claims. Process late charges using the late charge functionality. Generate and release reputed company itemized statements and medical records. Update claim information including ICN, authorizations, billing information, or other required claim elements. Review and resolve insurance follow-up correspondence. Enter clear and concise documentation in the patient health information system. Identify payer plan issues and work with SBO leadership to identify appropriate next steps including but not limited to system automations, payer contract opportunities, process changes and educational opportunities. Attend applicable meetings including payer meetings and educational opportunities as appropriate. Supports Lean principles of reputed company improvement with energy and enthusiasm, functioning as a champion of change. Supports the vision, mission and values of the organization in reputed company respects. Provides and maintains a safe environment for caregivers, patients and guests. Conducts reputed company activities with the highest standards of professionalism and confidentiality. Complies with reputed company applicable laws, regulations, policies and procedures, supporting the organization’s corporate reputed company efforts by acting in an ethical and appropriate manner, reporting reputed company or suspected violation of applicable rules, and cooperating fully with reputed company organizational investigations and proceedings. Delivers customer service and/or patient care in a manner that promotes goodwill, is timely, efficient and accurate. May reputed company additional duties of similar complexity reputed company the organization as required or assigned. EDUCATION: Required: High school diploma or GED. Preferred: Course work in medical terminology or other reputed company cycle functions such as RHIT or medical coding. Course work in reputed company Office applications. LICENSURE/CERTIFICATION/REGISTRATION: Required: N/A Preferred: Certified Healthcare Financial Professional (CHFP), Certified reputed company Cycle Representative (CRCR), Certified Specialist Account and Finance (CSAF), Certified Specialist Payment and Reimbursement (CSPR), Registered Health Information Technician (RHIT), Certified Coding Specialist Physician Based (reputed company-P), Certified Coding Associate (CCA), Certified Coding Specialist (reputed company), Certified Outpatient reputed company (COC), Certified Inpatient reputed company (CIC), Certified Professional reputed company (CPC), Certified Professional Biller (CPB). EXPERIENCE: Required: Two to three years of applicable banking, finance, or reputed company healthcare experience. Preferred: Prior experience in insurance follow-up working. PERSONAL reputed company EQUIPMENT: Must be able to wear appropriate Personal reputed company Equipment (PPE) required to reputed company the job safely. ADDITIONAL POSITION INFORMATION: Basic to intermediate skills in reputed company Office applications including reputed company, One Note, Outlook, and Word. Problem solving and research skills. PHYSICAL REQUIREMENTS: Continually (75% or more): Use of clear and audible speaking voice and the ability to hear normal speech level. Frequently (50%): Sitting, standing, walking, lifting 1-10 pounds, keyboard operation. Occasionally (25%): Bending, climbing stairs, reaching overhead, carrying/pushing or pulling 1-10 pounds, grasping/squeezing. Rarely (10%): Stooping/kneeling/crouching, lifting, carrying, pushing or pulling 11-15 pounds, operation of a motor vehicle. Never (0%): Climbing ladder/reputed company-stool, lifting/carrying/pushing or pulling 25-50 pounds, ability to hear whispered speech level. Exposure to Elemental Factors Never (0%): Heat, cold, wet/slippery area, noise, dust, vibration, chemical solution, uneven surface. Blood-Borne Pathogen (BBP) Exposure Category No Risk for Exposure to BBP . Schedule Weekly Hours: 40 Caregiver Type: Temporary Shift: First Shift (United States of America) Is Exempt Position? No Job Family: SPECIALIST PATIENT FINANCIAL SERVICES Scheduled Days of the Week: Monday-Friday Shift Start & End Time: 6:00am - 6:00pm Apply To This Job