Icon hamburger
US
What job do you want?
Apply to this job.
Think you're the perfect candidate?
Apply Now
Thumsup

You’re being taken to an external site to apply.

Enter your email below to receive job recommendations for similar positions.
Default2

DENIALS ANALYST

Riverside Medical Center Kankakee Full-Time
Apply Now

Summary:

The Denials Analyst position reports to the Manager of Revenue Integrity.  Responsible for immediate review of all denied claims, identification of the basis for filing an appeal, and/or resubmission of an accurate, compliant and timely claim and/or appeal letter resulting in reconsideration by the third party payer or upholding denial resulting in write-offs.

Experience/Education Requirements:

  • High School graduate or equivalent
  • Previous Collections or Insurance experience within last 3 years, preferred
  • ICD9/CPT/Medical terminology preferred
  • PC and Keyboarding Skills (30 WPM Preferred)
  • Ability to work independently
  • HRMA Credentialed Revenue Cycle Representative (within 2 years of hire)
  • Two years hospital patient accounting experience, preferred

License or Certification Requirements:

  • After 2015, HFMA Credentialed Revenue Cycle Representative required within 2 years of hire

Work Schedule: Days

FTE: 1.0

Location: Hoover - Kankakee

 

Responsibilities:

  • Daily review of denials identified by 835 files, manually posted R/As, EOBs, or Payer Correspondence in the Patient Accounting and/or Scanning system.
  • Denial prevention - Identify denial trends; provide documentation, data and reporting to Senior Management and offer suggestions for process improvement to areas involved.
  • Develop, implement and evaluate existing policies and procedures related to denials management.
  • Identify and communicate system issues related to denials stemming from billing, edits, rejections and follow up work queues with the Epic Coordinators and Revenue Cycle Manager.
  • Submit help tickets and work with Epic Application Coordinators and/or Analytics to resolve issues, including testing and training as necessary.
  • Insure that all Clinical denials are assigned to the appropriate workflow and are written timely by the Utilization Review Staff.
  • Maintain attendance at Managed Care In-services, onsite meetings and conference calls with Insurance Provider Representatives.
  • Other duties as assigned.
  • Provide training to peers assisting with denial management.
  • Provides input as well as assisting with quality assurance process initiatives for Riverside Medical Center's Revenue Cycle as related to the improvement of the root cause of the denial.
  • Responsible for submitting all Outpatient appeals denied due for Technical reasons.
  • Responsible to maintain the Denial Management system and workflow.
  • Working with the Application Analyst, the Denials Analyst will thoroughly test and document system upgrades and software modifications related to the Denial Management system.
  • Timely follow up on all successfully submitted appeals, by use of work lists and queues, until a determination is made on the appeal.

 #CB

To apply please email your resume to Email blocked - click to apply 

Riverside Healthcare is revolutionizing care using leading-edge technology to diagnose and treat patients. We are ranked top in the nation for performance in neurosurgery, orthopedics, and heart surgery and have also been named one of the nation's 100 Top Hospitals® by Truven Health Analytics seven times. Riverside is nationally recognized for our specialty programs in obstetrics, trauma, oncology, rehabilitation, geriatrics, occupational health, psychiatric services, and treatment of alcohol and chemical dependency, as well as patient safety. We combine innovation and convenience at state-of-the-art facilities located in communities throughout the greater Kankakee area.

Riverside Medical Center proves that truly progressive medicine is being delivered in Chicago’s southwest suburbs and East Central Illinois. Join a team that is not only concerned with providing the best care possible but also with offering a work environment of advancement and growth. Riverside is a place that embraces a culture where opinions count and dedication is respected, where superior performance is rewarded with competitive salaries and excellent benefits.

 
Apply to this job.
Think you're the perfect candidate?
Apply Now

Help us improve CareerBuilder by providing feedback about this job: Report this job

Report this Job

Once a job has been reported, we will investigate it further. If you require a response, submit your question or concern to our Trust and Site Security Team

Job ID: 1383

CAREERBUILDER TIP

For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.

Riverside HealthCare a fully integrated healthcare system serving the needs of patients throughout the counties of Kankakee, Iroquois, Will, Grundy and beyond. Riverside HealthCare is comprised of four entities:

Riverside Medical Center is located in Kankakee, Illinois, and is part of Riverside HealthCare, a fully integrated healthcare system serving the needs of patients throughout the counties of Kankakee, Iroquois, Will, Grundy and beyond. Riverside Medical Center is a 325-bed hospital that provides a full scope of inpatient and outpatient care. Riverside is a nationally recognized, award-winning hospital with leading programs in heart care, cancer care, neurosurgery and orthopedics. It is the area’s only Magnet® Recognized hospital and has been named a 100 Top Hospital four years in a row. Riverside also operates several community, primary and specialty health centers throughout the region.

Sojourn, a Riverside community, addresses the health care needs of the area’s elderly population. The four facilities that are a part of Riverside Senior Living Center include: Butterfield Court, an assisted living facility, Miller Center, a skilled nursing facility and Westwood Oaks/Westwood Estates, independent retirement communities.

Oakside Corporation operates the Riverside Health Fitness Center and also coordinates community counseling programs, pharmacy, health equipment sales and leasing and home health care.

Riverside HealthCare Foundation raises funds for the health system for use in facility construction and repair, new equipment acquisition, community health care education initiatives and clinical research.

View the full profile