[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 Graduate with some College
• 5+ years’ experience in medical billing/collections setting with experience in denials, appeals, insurance collections, and related follow-up
• Extensive knowledge of ICD9 and CPT-4 coding and modifiers usage
• Good working knowledge of 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 analytical skills
• 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

• Focused denials and appeals management experience
• 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

• 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 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
• Function as a denials team resource to other associates within the department
• Ability to lead a team meeting and teach specific tasks 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