Insurance Follow-Up Specialist

Pay range: $22.91 - $32.07 per hour, based on experience.
This position comes with a comprehensive benefits package that includes medical, dental, vision, a 403(b) retirement plan, and a generous Earned Time Off (ETO) program.
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.
** ST. CHARLES HEALTH SYSTEM

JOB DESCRIPTION
***
* TITLE:

** Insurance Follow-up and Denials Specialist 2
** REPORTS TO POSITION:
** Claims Supervisor
** DEPARTMENT:
** Single Billing Office
** DATE LAST REVIEWED:
** August 2024
** OUR VISION:
** Creating America’s healthiest community, together
** OUR MISSION:
** In the spirit of love and compassion, better health, better care, better value
** OUR VALUES:
** Accountability, Caring and Teamwork*
* **** DEPARTMENTAL

SUMMARY:

** The Single Billing Office (SBO) rles Health System (SCHS) provides revenue cycle services to our multi-hospital and medical group organization focusing on billing, collecting, and posting revenue. The goal of the SBO is to deliver a delightful, transparent, and seamless experience to patients and customers that captures and collects the revenue 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 contracts 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 2
** works intermediate payer denials which require a higher-level understanding of payer reimbursement methodologies, billing, and coding requirements. Caregivers actively work to identify denial trends and possible solutions to resolve or mitigate these trends. This position must also be able to assist other caregivers and is therefore required to understand all level one follow-up tasks. 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 all payers and denials in a single financial class. Work may be sub-divided by dollar amount or denial type with a focus on intermediate dollar range ($5,000 to $15,000) and intermediate denials (HB OP and PB).Identify and resolve intermediate denials through research, appeals, correcting and rebilling claims, locating and correcting coverage, submitting records, and escalating to payer and/or leadership.

Verify and update insurance coverage as applicable using EHR tools, payer websites, or via phone calls to payers.

Apply root case net adjustments when all collection options are exhausted.

Resolve claim edits within Medicare billing system (DDE).Resolve payer and clearinghouse rejections (277’s).Apply intermediate to advance research methodologies consistent with SBO department complexity matrix.

Intermediate denials include but are not limited to (see department matrix for complete list):
* Intermediate billing requirements errors
* Intermediate charging related denials
* Intermediate coding related errors
* Inpatient Medical Necessity (Level of Service)
* Inpatient Notifications
* Inpatient Only Procedures (PB and HB)
* Inpatient length of stay authorizations
* Intermediate Medical Necessity
Apply intermediate knowledge of current reimbursement methodologies and billing requirements consistent with SBO complexity matrix.

Work to identify and…