Specialist-Denials Management (Remote)

Spartanburg Regional Healthcare System • Spartanburg, SC

2d • Remote

About The Position

The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager. Only Applicants from the following states: Alabama, Arizona, Connecticut, Delaware, Florida, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin.

Requirements

• High School Diploma or equivalency
• 4 years' experience in medical billing, setting with exposure to denials, appeals, insurance collections and related follow-up.
• Must have good knowledge of ICD9 and CPT-4 coding
• Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
• Be familiar with multiple payer requirements for claims processing
• Solid skills with Microsoft office with a focus on Excel and Word.
• Good Communication Skills

Nice To Haves

• Associates or Bachelor's degree in a Healthcare related field.
• Focused denials and appeals management experience.
• CPC and/or CPC-H certification

Responsibilities

• Research and resolve all outstanding denials within workque and complete all necessary follow up within a timely and accurate manner
• Identify all denial trends and provide education of steps to prevent future avoidable denials.
• Initiate/manage all insurance appeals in a timely manner
• Manage outstanding AR related to denials.
• Communicate all denial trends and denial increases to direct supervisor/manager in order to positively affect the volume of denials
• Organize the workflow to ensure that denials are worked according to departmental policy and standards.
• Manage correspondences and any ADR requests as defined within department workflow procedure to ensure timeless and accuracy of response.
• Complete special projects as assigned by Supervisor/Manager
• Prepare/attend AR denial meetings as required.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED