Specialist-Sr Denials Management (Remote) at Spartanburg Regional Healthcare System

Spartanburg, South Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

17 Oct, 26

Salary

0.0

Posted On

20 Jul, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Denials Management, Medical Billing, Insurance Collections, ICD9 Coding, CPT-4 Coding, EOB Analysis, Microsoft Excel, Microsoft Word, Analytical Skills, Communication Skills, Claims Processing, Appeals Management

Industry

Hospitals and Health Care

Description

Job Requirements Position Summary 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, Georgia, Indiana, Kansas, Kentucky, Louisiana, Maryland, Michigan, North Carolina, Pennsylvania, Rhode Island, South Carolina, Virginia, West Virginia, Wisconsin. Minimum Requirements Education High School Graduate with some College Experience 5+ years’ experience in medical billing/collections setting with experience with denials, appeals, insurance collections and related follow-up. Must have extensive knowledge of ICD9 and CPT-4 coding and modifiers usage. 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 Analytical skills. Good Communication Skills License/Registration/Certifications N/A Preferred Requirements Preferred Education N/A Preferred Experience Focused denials and appeals management experience. Possess an 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. Preferred License/Registration/Certifications If in Professional Billing Services: CPC certification If in Hospital Billing Services: CRCA or CPC-H certification Core Job 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.

Responsibilities

The role involves reviewing and resolving daily claim scrubber edits and managing outstanding AR related to insurance denials. The specialist is also responsible for identifying denial trends, managing appeals, and providing education to prevent future avoidable denials.