Overview
Specialist-Sr Denials Management (Remote) Jobs in Spartanburg, SC at Spartanburg Regional Healthcare System
Title: Specialist-Sr Denials Management (Remote)
Company: Spartanburg Regional Healthcare System
Location: Spartanburg, SC
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
- If in Professional Billing Services: CPC certification
- If in Hospital Billing Services: CRCA or CPC-H certification
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 Hospital Billing Services: an AAPC credential
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.