Denials Specialist

About the Role

LaSalle Network is partnering with our client to hire a Denials Specialist in Skokie, Ill., for a contract-to-hire opportunity. This Denials Specialist role is ideal for someone who enjoys blending denial and appeal work with data integrity, reporting and cross-functional collaboration. In this on-site environment, the Denials Specialist will support denial prevention and revenue protection across multiple payor types while staying current on evolving regulatory requirements.

Responsibilities

• Oversee denial and appeal workflows using the denial management system, including documentation, deadline tracking and timely payment/adjustment processing
• Audit denial data to correct errors, maintain data integrity and develop standard and ad-hoc reports to identify trends and variances
• Perform root-cause analysis on denials and provide feedback and education to departments and physician offices to reduce denials and improve processes
• Maintain current knowledge of Medicare, Medicaid and managed care requirements, including monitoring CMS guidance and industry changes
• Serve as a liaison across hospital departments and off-site facilities to support denial prevention and optimal reimbursement
• Perform RAC account review and reconciliation, including appeals for medically unlikely edits (MUE) rejections and related adjustments/refunds as appropriate
• Complete adjudication-related work, including calculating allowances, identifying contract inconsistencies and correcting account/insurance errors

Qualifications

• High school diploma or equivalent required; associate degree in business, accounting or health care, or bachelor's degree preferred
• Minimum three years of experience in adjudication, reimbursement, denial management, utilization review or equivalent experience in a health care environment
• Epic experience required
• Knowledge of reimbursement models and related federal, state and regulatory rules and regulations (including Medicare, Medicaid and managed care)
• Proficiency with Microsoft Office products
• Familiarity with claims processing and coding concepts (CPT, HCPCS, DRGs and ICD-9/10)
• Strong analytical, critical thinking, communication and writing skills, including the ability to draft clear, persuasive appeal letters
• Intermediate to advanced computer skills and the ability to navigate multiple systems and payer portals; experience with tools such as Cobius, AEOS, Word, Access and Excel is beneficial
• Ability to manage workload through automated processes, multitask effectively and work a flexible schedule

Pay & Schedule

• Employment Type: Contract-to-Hire
• Compensation: $25 - $28 per hour
• Location: Skokie, IL
• Work Model: On-site