Spartanburg Regional Healthcare System

Compensation

Full Description

Job Requirements Position Summary The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager. Minimum Requirements Education • High School Diploma or equivalency Experience • 4 years' experience in medical billing, setting with exposure to denials, appeals, insurance collections and related follow-up. • Must have good knowledge of ICD9 and CPT-4 coding • Must have a good working knowledge with insurance explanation of benefits (EOB) and comprehensive understanding of remittance and remark codes. • Be familiar with multiple payer requirements for claims processing • Solid skills with Microsoft office with a focus on Excel and Word. • Good Communication Skills License/Registration/Certifications • N/A Preferred Requirements Preferred Education • Associates or Bachelor's degree in a Healthcare related field. Preferred Experience • Focused denials and appeals management experience. Preferred License/Registration/Certifications • CPC and/or CPC-H certification Core Job Responsibilities • Research and resolve all outstanding denials within workque and complete all necessary follow up within a timely and accurate manner • Identify all denial trends and provide education of 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 in order 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 timeless and accuracy of response. • Complete special projects as assigned by Supervisor/Manager • Prepare/attend AR denial meetings as required.