Denial Reimburse Specialist

The Denial Reimburse Specialist is responsible for the immediate review of all denied medical insurance claims, identification of the basis for filing an appeal, and/or resubmission of claims. This position ensures that resubmitted claims are accurate, compliant and timely, resulting in reconsideration by third-party payers.

WHO WE ARE
With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU WILL DO

• Conduct inquiries via phone, mail, fax, or electronically to conduct follow-up on the accounts that have not been denied and resubmitted for payment.

• Conduct follow-up with insurance carriers, physicians, and other stakeholders that can validate and assist with actions and information needed in order to properly review, dispute or appeal denial until a determination is made to conclude the appeal.

• Resubmit upheld denials as warranted and monitor resubmissions for payment; resubmit claims using the denial program re-bill requests feature, ensuring all modifications to the account are reflected on the claim form.

• Ensure information sent to insurance carriers have all release of information necessary and is HIPPA compliant.

• Analyze reports and use software to track, trend and identify root causes of denials; offer suggestions for process improvement to resolve denial issues, supported by documentation and data.

• Review denials and payment discrepancies identified through the denial system, which are directly related to the verification, authorization and registration process.

• Prepare and submit patient record requests from care delivery sites and provide correspondence to patient on requested information.

QUALIFICATIONS

• Preferred Associate's degree

• Required High School Diploma/GED

• 2 years Revenue Cycle Required

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.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.