[Hiring] Denial Management Specialist @Spartanburg Regional Healthcare System

Role Description

The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.

Qualifications

• High School Diploma or equivalency
• 4 years' experience in medical billing, with exposure to denials, appeals, insurance collections, and related follow-up
• Good knowledge of ICD9 and CPT-4 coding
• Good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes
• Familiarity with multiple payer requirements for claims processing
• Solid skills with Microsoft Office, focusing on Excel and Word
• Good communication skills

Requirements

• 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

Preferred Requirements

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

Core Job Responsibilities

• Research and resolve all outstanding denials within work queue and complete all necessary follow-up in a timely and accurate manner
• Identify all denial trends and provide education on 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 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 timeliness and accuracy of response
• Complete special projects as assigned by Supervisor/Manager
• Prepare/attend AR denial meetings as required