Job Description

Location: Chicago, IL

Hospital: RUSH University Medical Center

Department: HB Commercial Billing/Collect

Work Type: Full Time (Total FTE between 0.9 and 1.0)

Shift: Shift 1

Work Schedule: 8 Hr (8:00:00 AM - 4:30:00 PM)

Summary:

Responsible for assisting the Denial Management team with various duties including understanding the denial, maintaining a filing system from various payers for record management, reviewing denial data from our all payers for accuracy of information and writing appeal letters as needed. Exemplify the Rush mission, vision and values and acts in accordance with Rush policies and procedures.

Other information:

Required Job Qualifications:

HS Diploma

• 2 years’ experience in a healthcare environment.

• General knowledge of the healthcare field.

• Working knowledge of Epic.

• Advanced knowledge of the review process for commercial payers and government review agencies.

• Strong computer, interpersonal and mathematical skills.

• Technical aptitude with the ability to quickly gain proficiency with relevant computer applications.

• Proficiency with Microsoft Office.

• Ability to perform multiple tasks with strong time management skills.

Responsibilities:

1. Writes standard appeal letters to Managed Care payers and submit charts when needed with these appeals. Works with Rush University Medical Center and Rush Oak Park Hospital departments as needed to obtain any missing information.

2. Maintains thorough understanding of medical policies and applies them to current denial situations. Attends payer meetings as needed.

3. Contacts physician offices and works with their staff to identify rationale and resolve denials.

4. Manages assigned work queues in Epic. Assigns cases to denial management representatives as needed.

5. Acts as the first point of contact for resolution of escalated issues internally. Escalates issues to manager or payers as needed.

6. Documents activity in all HCF systems with narratives of action taken.

7. Serves key role as mentor and trainer to other denial management representatives and other sections of Healthcare Finance as needed.

8. Denial Avoidance / Payment delay management.

9. Identifies trends and assists with developing process improvements.

10. Collaborates with other Healthcare Finance members when technical issues arise.

11. Creates BDC records in Epic.

12. Demonstrates contributions to financial goals reflected by suggested process improvements.

13. Identifies and prints the needed medical records in Epic.

14. Willingness to engage in continual education and training in the subject field.

15. Participates in educational activities.

16. May lead and direct work of others; assists with training new staff as needed.

17. Maintains strictest confidentiality.

18. Performs special projects as assigned by the Director of Revenue Management.

Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, and other legally protected characteristics.

Position Financial Service Representative 3

Location US:IL:Chicago

Req ID 8269