Lead Denial Reimbursement Specialist

At Franciscan, our Lead Denial Reimburse Specialist need a full understanding of the denial, appeal, and follow-up process. In this role you will act as a liaison between the Denial Management Team and other revenue cycle departments and be responsible for working assigned work queues and ad hoc work queues. You will also work projects as needed, complex denials, and assist team members with difficult denial situations. You will have the opportunity for training/onboarding new hires, retraining existing staff, and training all staff on new workflows.
 
WHO WE ARE

Franciscan Health is a leading healthcare organization dedicated to providing exceptional patient care and promoting health and wellness in our community. Our mission is to ensure that every patient receives the highest quality of care through innovation, compassion, and excellence. 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 who provide compassionate, comprehensive care for our patients and the communities we serve.
WHAT YOU CAN EXPECT

• Provide training and education for new hires and staff, including new and updated processes.

• Monitor the operations of a unit and provide input into the performance of individuals through feedback and recommendations.

• Monitor a structured, organized workflow to ensure departmental actions are carried out consistently and accurately using a proper distribution of work.

• Conduct follow up with insurance carriers, staff and other stakeholders that can validate and assist with providing information to properly review, dispute or appeal a denial.

• Investigate claim and payment history for appealing a claim. Collect appropriate documentation and write-offs as needed as well as review RAC Audits and rejected claims based on NPI denials.

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

QUALIFICATIONS

• Preferred Associate's Degree

• Required High School Diploma/GED

• 2 years Patient accounting, with abilities in denials, billing, collections, customer service or cash application Required

• 1 year Microsoft office, managed care contract terminology Preferred

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.