[Hiring] Denials Specialist @ECU Health Medical Center

Role Description

The Denials Specialist will be responsible for researching, analyzing, resolving and trending rejections and/or denials specific to the revenue 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.
• Ensuring that the claim is adjudicated.

The Denials Specialist should be able to:

• Identify potential process improvement opportunities.
• Offer recommendations for correcting issues.
• Understand how various components of the revenue cycle can cause a denial.
• Be a problem solver and utilize available resources to rectify a denial.

Additional responsibilities include:

• Analyzing Managed Care contracts and reconciling payments received.
• Contacting insurance companies to have adjustments processed and/or file appeals.
• Direct interaction with Managers and/or Department Heads regarding administrative issues related to rejections and/or denials.

Qualifications

• High school diploma, equivalent or higher.
• 5 or more years of experience in billing, A/R follow up, denials management & appeal writing.

Requirements

• 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 all ancillary charges and multi-specialty departmental functions.
• Communicate orally and in written form.
• Understand insurance terms and payment methodologies.
• Work effectively with physicians, administrative staff, and department managers.
• Identify accurate Revenue code(s), CPT codes, and HCPCS codes for services/items.
• Identify clerical errors, mistakes in interpretation, imprecise records, and inaccurate service code assignment.
• Perform reviews for appropriateness of coding and charging.

Benefits

• Pay Range: $24.69 - $35.99/hr
• Remote role (based out of Greenville, NC)
• Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. ET
• Great Benefits