IMH PFS Denial Specialist, Full Time - Days

<strong>Job Description<br><br></strong>Join <strong>Ingalls Memorial Hospital</strong> as a <strong>Patient Financial Services</strong> <strong>Denial Specialist</strong>. Here, you will join our Revenue Cycle team at our <strong>Burr Ridge</strong> 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.<br><br>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.<br><br><strong>Essential Job Functions<br><br></strong><ul><li> 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 </li><li> Works closely with insurance and managed care companies to ensure proper review and processing of denied claims </li><li> Acts as a liaison between insurance companies and physicians to provide medical necessity for denied claims </li><li> 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 </li><li> Conducts relevant research to assist with completing the appeals process and to stay informed on best practices and policy reforms </li><li> 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 </li><li> Contacts patients to communicate insurance coverage denials and works with the patient to overturn the denials related to patient information needed </li><li> 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 <br><br></li></ul><strong>Required Qualifications<br><br></strong><ul><li> High school diploma or equivalent </li><li> Minimum 3 years of experience in healthcare billing, collections, payment processing, or denials management (Denial Management experience preferred). </li><li> Minimum 3 years of experience using computer programs for tracking denials and appeals </li><li> 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 <br><br></li></ul><strong>Position Details<br><br></strong><ul><li> Job Type: Full Time (1.0 FTE) </li><li> Shift: Days </li><li> Work Location: Flexible Remote – Burr Ridge </li><li> Department: Revenue Cycle </li><li> CBA Code: Non-Union <br><br></li></ul><strong>About Us<br><br></strong><em>We’ve been at the forefront of medicine since 1899. We provide superior healthcare with compassion, always mindful that each patient is a person, an individual. 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 is for you. Here at the forefront, we’re doing work that really matters. Join us. Bring your passion.<br><br></em><em>UChicago Medicine is growing; discover how you can be a part of this pursuit of excellence at: </em> <em>UChicago Medicine Career Opportunities<br><br></em><em>UChicago Medicine 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.<br><br></em><em>As a condition of employment, all employees are required to complete a pre-employment physical, background check, drug screening, and comply with the flu vaccination requirements prior to hire. Medical and religious exemptions will be considered for flu vaccination consistent with applicable law.<br><br></em><strong>Compensation & Benefits Overview<br><br></strong><em>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.<br><br></em><em>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.<br><br></em><em>Review the full complement of benefit options for eligible roles at </em> <em>Benefits - UChicago Medicine</em> <em>.</em>

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...