DENIALS SPECIALIST - CENTRAL BILLING OFFICE

Life Changing Careers Start Here!

Northern Regional Hospital is always looking for talented individuals to join our dedicated staff. We are proud to be a “Five-Star” hospital.

Our superior ratings are a testament to our team’s commitment to quality and service excellence. We seek talented and diverse faculty and staff to continue to provide superior care.

Northern is a place where you can grow your career, no matter where you are professionally. We believe you will find it to be more than just a job. When you choose to work at Northern, you become part of a family of caregivers supporting the communities we serve.

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Choose Well. Choose Northern.

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At Northern, we strive to provide benefits that meet you where you are–not only today, but tomorrow.

We recognize that our ultimate success depends on our talented and dedicated workforce – our Northern Stars.

We understand the contributions of each employee to make our accomplishments possible. Our goal is to provide a comprehensive program of competitive benefits to meet your needs today and anticipate your needs tomorrow. Through our benefits programs, we strive to support you and your family by providing a benefit package that is easy to understand, easy to access and affordable.

• Competitive Compensation – and be paid daily!

You deserve to get paid every day so we’ve partnered with DailyPay so you can get your pay any time before payday!

• Medical, Dental, and Vision Insurance
• Paid Time Off
• Short Term and Long Term Disability Insurance
• Life Insurance for Employee, Spouse, and/or Dependents
• Accidental Death and Dismemberment Insurance
• Accident, Critical Illness and Hospital Indemnity
• Flexible Spending Accounts (FSA) for Healthcare and Daycare Expenses
• Northern $elect Retirement Plan (403(b) and 457(b)) and Roth IRA
• Educational Assistance of up to $10,000 per program or degree
• Celebrate! - Pick a gift to recognize your fifth anniversary and every five years of service thereafter
• 50% discount on membership at Northern Wellness & Fitness Center
• Employee discount programs
• Employee Health Clinic

1. Reviews and researches claims in which a denial of payment has been received from the payer.
2. Identifies the root cause of the denial in order for the issue to addressed with the appropriate
department (i.e. Billing, CDM, Clinical Documentation, Coding, etc.) by the Denials Task Force.
3. Utilizes all appropriate systems to effectively research claims and complete steps to submit
information necessary to process or appeal claims. Investigates and ensures that questions and
requests for information are responded to in a timely and professional manner to ensure resolution of
outstanding claims.
4. Completes follow-up with patients, as necessary, to obtain additional information.
5. Prepares necessary documentation to submit appeals to payers when payment is delayed or denied.
Rebills or reprints claims as necessary and appropriate.
6. Completes and requests adjustments to a claim, as appropriate, based on the dollar threshold of the
adjustment.
7. Reviews, works and reports all claims that have aged more than the specified grace period stipulated in
the policies and / or contracts.
8. Tracks and reports violation of prompt pay / adjudication terms by payers and follows up proactively
with payers to provide necessary additional documentation for patient claims that have been reviewed
by payers and are awaiting documentation to determine adjudication.
9. Documents patient claims appropriately. Updates the claim with appropriate transactions to reflect
current collection status.
10. Reports issues and trends to appropriate CBO management personnel and works collaboratively to
develop solutions.
11. Organizes work and resources to accomplish objectives and meet deadlines. Demonstrates problemsolving skills related to denial analysis.
12. Demonstrates the willingness and ability to work collaboratively with other key internal and external
staff to obtain necessary information to address denial issues. Provides direction to members of the
team, serves as a resource for questions.
13. Participates in all educational activities and demonstrates personal responsibility for job performance.

• High school diploma or GED.
• Two years' experience insurance follow-up, denials management, or medical billing.
• Proficient in Meditech Expanse, Microsoft Office including but not limited to Excel & Outlook.
• Working knowledge of government and non-government payer practice regulation standards and reimbursement.