PFS Pt Acct Denial Spclst - PFS Hospital - Home - FT/Days

Remote, USA

PFS Pt Acct Denial Spclst - PFS Hospital - Home - FT/Days

Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. We are committed to transforming the health care experience with high-quality care for every stage of life. Our service-oriented mission is in action every day, whether it’s by providing care in our facilities, training the next generation of health care professionals, or serving others through international outreach.


Campus Overview

Kettering Health Main Campus

  • Kettering Health Main Campus, formerly Kettering Medical Center, is the flagship hospital of Kettering Health and has been serving Kettering, Ohio and the Greater Dayton area since 1964.
  • The facility includes the Benjamin and Marian Schuster Heart Hospital, maternity service with a level III neonatal intensive care unit (NICU), and level II Emergency Care.
  • In 2020, KH Main Campus received an “A” from the Leapfrog Group, a national patient safety watchdog, ranking among the safest hospitals in the United States.
  • Received 4 Star Baby-Friendly Hospital status by the Ohio Hospital Association.
  • Awarded as one of the 50 Top Cardiovascular Hospitals by IBM Watson Health in 2020.
  • Kettering received the Outstanding Patient Experience Award by Healthgrades (2017-2019).
  • Accredited by the American College of Emergency Physicians as a Level 3 Geriatric Emergency Department.
  • 465-bed hospital (includes newborn beds)

Department Overview

The Patient Accounts Denial Specialist is responsible for monitoring denials, appeals, takebacks, and resolutions from insurance carriers and working proactively to collect outstanding denied accounts. The job responsibilities and duties include: Identifying, analyzing, and researching frequent root causes of denials and develop corrective action plans for resolution of denials. Position will be required to be detailed oriented and formulated appeals researching and analyzing denial data and coordinating denial recovery responsibilities. Candidate will be required to be knowledgeable, understand, and apply critical thinking skills to the correct appeal methodology to help address various denials such as proving medical necessity and retro authorizations appeals. Specialist are required to apply the proper escalation of outstanding denials including submitting complaints to various agencies such as the Ohio Department of Medicaid and the Department of Insurance. In additional to denials, employee will address pre and post takebacks by health plans that are required to be investigated and appropriate action taken. Specialist must prioritize activities to work overturns in a timely manner to alleviate untimely filings is a must. Working with Insurance payers to ensure proper billing takes place on all assigned patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report to expedite resolution of accounts. Works follow up report daily, maintaining established goal(s), and notifies Team Lead and/or Supervisor, of issues preventing achievement of such goal(s). Follows up on daily correspondence to appropriately work patient accounts. Assists customer service with patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc. Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers, or employers, as appropriate. Sends initial or secondary bills to Insurance payers. Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assignedaccounts. escalation to Supervisor/Manager of any issues or changes in billing system, insurance carrier, and/or networks. Works other duties as assigned.

Responsibilities & Requirements