Job Description

Insurance Denials Rep

Cancer care is all we do

Hope in healing

Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.

Job Description:

*This position sits onsite in Zion, IL

Job Summary/Purpose:

Denials and Appeals Specialist (DAS) specialize in follow up of denied claims from all commercial and contracted payers. DAS’s are responsible to perform timely and appropriate validation and follow up denied claims, including the initial assessment of the denials received via the denials management systems queue (XDM) to determine the appropriate course of action for resolving the claims.  DAS’s thoroughly investigate denied claims to ensure timely and proper follow-up for addressing denials including assigning them to the appropriate resources within the denials and appeals management workflow, collaborating with the Clinical Appeals Program Manager to initiate the appeals process, and coordinating with the Insurance Claims Representative (ICR) and/or Accounts Management Specialist (AMS) to complete research to support the claim review and to determine and execute the appropriate course of action for resubmission of the claims to obtain reimbursement.  The DAS is also responsible for supporting the development of business processes for managing the denials and appeals process at CTCA.  They will provide system and process support to the broader multi-functional Denials and Appeals resources.  The DAS will support and administer training for XDM (the denials management technology) and participate in system support activities. The Denials and Appeals Specialists report directly to the Manager of Denials and Appeals.

Education/Experience Level

  • Must be a High School graduate or equivalent
  • Strong analytical skills.
  • College Degree Preferred.
  • Must have minimum of 1-2 years experience in registration, collection and verification in a healthcare setting or similar service profession.

Knowledge and Skills

  • Must have strong analytical and troubleshooting skills
  • Must have experience with account reconciliation and balancing
  • Must have excellent organizational skills, be highly productive and able to manage multiple priorities.
  • Must have good written and verbal communication skills.
  • Must have basic knowledge of medical terminology.
  • Knowledge of PC and other office equipment with Windows experience.
  • Must have experience with current ICD coding methodology, insurance terminology and ability to read an Explanation of Benefits.
  • Must have outstanding telephone communication and customer service skills.
  • Must be efficient, reliable, goal oriented and adaptable to change while maintaining productivity levels.
  • Must be able to perform routine mathematical, color coding and alphabetizing functions.
  • Must be Team oriented.
  • Must be courteous and professional.
  • Must be willing to travel as needed

#AF-HJ

We win together

Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. 

Visit:  Jobs.cancercenter.com to begin your journey.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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