[Hiring] Denials/Appeals Analyst @Singing River Health System

Role Description

The Denials and Appeals Analyst assists in the recovery of Health System revenue by managing the life cycle of denied claims. They work collaboratively with departmental peers throughout the System to achieve departmental and system-wide quality, satisfaction, and financial goals.

• Coordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager.
• Assures prompt action is taken on assigned denials by coordinating with clinical staff to create written and/or verbal clinical appeals with payers.
• Works closely with third party payors, Managed Care representatives, insurance billing staff, case management, and other service departments to resolve denied claims.
• Acts as a liaison to communicate claim denials related status and updated information to Organizational Leaders.
• Performs duties in accordance with Singing River Health System procedures and policies, accreditation organization, and governing guidance and publications for health care employees.

Qualifications

• High School Diploma or equivalent required; Associate’s degree preferred.
• Epic certification in Resolute Hospital Billing and/or Certified Coding Specialist preferred.
• Must have de-escalation training completed by the end of position orientation (90 days); must have appropriate level of de-escalation training.
• A minimum of three (3) years’ patient accounting and insurance experience required.
• Experience in a hospital and/or physician office preferred.

Requirements

• Work is moderately active: involves sitting with frequent requirements to move about the office, move about the facility, and to travel to another facility within the SRHS service area.
• Involves exerting a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.
• Subject to exposure to body fluids, sputum, and tissues, which may carry the hazard of infectious disease.
• Requires close visual acuity and the ability to adjust the eye to bring an object into sharp focus.
• Must be able to be active for extended periods of time without experiencing undue fatigue.
• Must be able to work schedules assigned with the understanding that changes may be instituted according to the needs of the hospital for off days, shifts, or weekends.

Benefits

• Superior customer service skills and professional etiquette.
• Proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook, and Word.
• Job may require traveling throughout the SRHS service area - with the employee providing their own transportation.
• Travel for education purposes may be required.