Patient Financial Service Denial Specialist

Rockville, MD
Apr 20, 2022
May 25, 2022
Full Time
Adventist HealthCare seeks to hire an experienced Patient Financial Service Denial Specialist who will embrace our mission to extend God's care through the ministry of physical, mental and spiritual healing.

The Denial Specialist has the primary responsibility of the daily reimbursement activities for claims submitted to third party payers. This position demonstrates a working knowledge of revenue cycle and reimbursement functions and a basic understanding of coding and billing requirements including ICD10, UB04, HCPCS and CPT (Current Procedural Terminology).

As an Patient Financial Service Denial Specialist, you will:

• The denials specialist determines root cause of denial or partially paid claim.
• Files Appeal after review of a denial indicates an appeal is needed or payer agrees to reprocess claim.
• Requests Rebill/Corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contacts payer either by phone call or online payer portal if determined that a denial was inappropriate.
• Routes denial to the appropriate team after denial has been determined that another department should resolve.
• Contacts payer either by phone call or online payer portal to determine if payer is requesting additional information in order to adjudicate claim.
• Requests Rebill/Corrections if denial has been reviewed and it is determined that a rebill is needed.
• Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
• Transfers unpaid balance to patient once determined patient responsibility.
• Reviews Explanation of Benefits
• Processes Payer changes if update or change is needed

Qualified candidates will possess:

• High School Diploma required or some college preferred.
• A minimum of 3 years' experience within a healthcare environment can include insurer, public health setting or an outsourcing company.
• Ability to work independently and in a team environment.
• Must maintain a high volume of processing without compromising quality and accuracy.
• Strong Customer Service skills.
• Ability to participate in an environment that promotes staff development, productivity, satisfaction and efficiency.

At Adventist HealthCare our job is to care for you. We do this by offering:
• Work life balance through non rotating shifts
• Recognition and rewards for professional expertise
• Free Employee parking
• Competitive comprehensive benefit plans offered (including health, disability, PTO and 403B retirement plan with matching and 3 year vesting)
• 100% Coverage for inpatient care - at Adventist HealthCare facilities
• 100% Coverage for urgent care nationwide - after copay

As a faith-based organization, with over a century of caring for the communities in the Maryland area, Adventist HealthCare has earned a reputation for high-quality, compassionate care. Adventist HealthCare was the first and is the largest healthcare provider in Montgomery County.

If you want to make a difference in someone's life every day, consider a position with a team of professionals who are doing just that, making a difference.

Join the Adventist HealthCare team today! Apply now to be considered.

Work Schedule:


7:30am - 4:00pm

8am - 4:30 pm

8:30am - 5:00pm

COVID-19 Vaccination

Adventist HealthCare requires all applicants to be fully vaccinated for COVID-19 before commencing employment. Applicants may be required to furnish proof of vaccination and , if offered, may elect to be vaccinated at a n designated Adventist HealthCare location.

Tobacco and Drug Statement

Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, Adventist HealthCare will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine and drug use.

While some jurisdictions, including Maryland, permit the use of marijuana for medical purposes, marijuana continues to be classified as an illegal drug under the federal Controlled Substances Act. As a result, medical marijuana use will not be accepted as a valid explanation for a positive drug test result.

Adventist HealthCare will withdraw offers of employment to applicants who test positive for Cotinine (nicotine) and marijuana. Those testing positive are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.

Equal Employment Opportunity

Adventist HealthCare is an Equal Opportunity/Affirmative Action Employer. We are committed to attracting, engaging, and developing the best people to cultivate our mission-centric culture. Our goal is to have a welcoming, equitable, and safe place to work and grow for all employees, no matter their background. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.

Adventist HealthCare will make reasonable accommodations for applicants with disabilities, in accordance with applicable law. Adventist HealthCare is a religious organization as defined under applicable law; however, it will endeavor to provide reasonable accommodations for applicants' religious beliefs.

Applicants who wish to request accommodations for disabilities or religious belief should contact the Support Center HR Office.

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