Specialist-Sr Denials Management (Remote)

Spartanburg Regional Healthcare System•Spartanburg, SC

5d•Remote

About The Position

The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager. This is a remote position, and applicants must be from Alabama, Arizona, Connecticut, Delaware, Florida, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, or Wisconsin.

Requirements

High School Graduate with some College
5+ years’ experience in medical billing/collections setting with experience with denials, appeals, insurance collections and related follow-up.
Extensive knowledge of ICD9 and CPT-4 coding and modifiers usage.
Good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes.
Familiar with multiple payer requirements for claims processing.
Solid skills with Microsoft office with a focus on Excel and Word.
Good Analytical skills.
Good Communication Skills.

Nice To Haves

Focused denials and appeals management experience.
In-depth working knowledge and experience with all types of insurance billing guidelines: Commercial, Medicare Part A and B, Medicaid, Managed Care plans etc.
Team lead or supervisory experience.
If in Professional Billing Services: CPC certification
If in Hospital Billing Services: CRCA or CPC-H certification

Responsibilities

Responsible to review and resolve all daily claim scrubbers edits based on coding/billing guidelines.
Research and resolve all outstanding denials within work cue 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.
Function as a denials team resource to other associates within the department.
Ability to lead a team meeting and teach specific task and procedures to other associates.
Must be cross-trained and functional in all areas within the department as it relates to A/R and denials.
Ability to work closely with multiple department leaders and/or staff to improve revenue integrity.
Complete special projects as assigned by Supervisor/Manager.
Prepare/attend AR denial meetings as required.