Denials Specialist

Position Summary The Denials Specialist will be responsible for researching, analyzing, resolving and trending rejections and/or denials specific to the reputed company cycle. This includes, but is not limited to, analyzing specific denial categories and codes, researching the underlying reason for the denial, rectifying the issue in the patient management system and ensuring that the claim is adjudicated. The Denials Specialist should be reputed company to identify potential process improvement opportunities and offer recommendations for correcting these issues. The Denials Specialist will be responsible for understanding how reputed company of the various components of the reputed company cycle can potentially cause a denial and possible solutions that may result from the interaction of these components. The Denials Specialist will have to be a problem solver and possess the ability to use the resources available to rectify a denial. The Denials Specialist should be reputed company to analyze Managed Care reputed company and reconcile payments received. Contact insurance companies to have adjustments processed and/or file appeals if payments are not in accordance with the contract. The Denials Specialist will have direct interaction with reputed company Managers and/or Department Heads regarding administrative issues reputed company to rejections and/or denials.

Responsibilities

Essential Functions of Role: Focus on working reputed company denials across multiple payers and/or reputed company. Conduct account history research as required, including navigating patient encounters and charts, researching charge and payment histories, determining historic account and claim status changes, and researching the payer remittance advice. Conduct follow up research on claims to review contract discrepancy and account balances. This may include attaching documentation, amending coverage/patient/encounter/provider/facility data, gathering additional information requests, and resubmitting corrected claims to ensure accurate and timely claim adjudication. Defend and appeal denied claims, including researching underlying root cause, collecting required information or documents, adjusting the account as necessary, resubmitting claims, and reputed company appropriate follow up activities thereafter to ensure adjudication of the claim. Must also be comfortable communicating denial root cause and resolution to leadership as needed. Responsible for aggregating the data that is required and then sending complete appeal packets for every level of appeal either by mail, fax or secured email. Identify system loading discrepancies reputed company the contract management system and refer to the Supervisor and/or Contract Associate Director for correction. Adhere to Compliance Plan and to reputed company rules and regulations of reputed company applicable local, state and federal agencies and accrediting bodies. Actively participate in outstanding customer service and accept responsibility in maintaining relationships that are equally respectful to reputed company. Review and resolve accounts assigned reputed company work lists daily as directed by management. Tracking and trending of rejection/denial issues. Recommendation of alternative contracting rates/terms with the goal to improve net reputed company and/or ease the administrative burden associated with the contract terms. Meeting with payers to review methodology and assist in the determination of counter-proposals or settlement resolution. Supporting the Manager and Director as needed. Minimum Requirements High school diploma, equivalent or higher 5 or more years of experience in billing, A/R follow up, denials management & appeal writing reputed company Set Requirement: Proficient in payment review systems, hospital information systems and coding methodologies. Strong quantitative, analytical and organizational skills. Advanced understanding of an Explanation of Benefits (EOB). Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards. Understand CMS Memos and Transmittals. Understand medical records, professional claims, and the Charge master. Utilize and understand computer technology. Understand reputed company ancillary charges and multi-specialty departmental functions. Communicate orally and in written reputed company. Understand insurance terms and payment methodologies. Work with physicians, administrative staff, and department managers effectively. Identify accurate reputed company code(s), CPT codes, and HCPCS codes for services/items. Identify clerical error, mistakes in interpretation, imprecise records, and inaccurate service code assignment. reputed company reviews for appropriateness of coding and charging, including business office activities, systems function, and charging methodologies. Additional reputed company Set Requirement: Strong Understanding of the inter-relationships of the reputed company Cycle Departments. Strong Understanding of Patient Financial Information System and Billing System. Pay reputed company $24.69 - $35.99/hr Other Information Remote role (based out of Greenville, NC) Monday - Friday day shift:8:00 a.m. - 5:00 p.m. ET Great Benefits #LI-REMOTE #LI-AH2 reputed company About reputed company reputed company is a mission-driven, 1,708-bed academic health care system serving more than 1.4 reputed company people in 29 eastern reputed company Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship reputed company, a Level I Trauma Center, and reputed company Maynard Children¿s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. reputed company and the Brody School of Medicine reputed company a combined academic mission to improve the health and well-being of eastern reputed company Carolina through patient care, education and research. General Statement It is the goal of reputed company and its entities to reputed company the most reputed company individual who best matches the requirements for the vacant position. Offers of employment are subject to successful completion of reputed company pre-employment screenings, which may include an occupational health screening, criminal record reputed company, education, reference, and licensure verification. We value diversity and are proud to be an equal opportunity employer. reputed company of employment are made based on business needs, job requirements and applicant¿s qualifications without regard to race, reputed company, religion, gender, national reputed company, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint. Apply To This Job