Denials Management Specialist in Spartanburg, SC at Spartanburg Regional Healthcare System

Date Posted: 6/27/2019

Job Snapshot

Job Description

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

  •  Responsible to 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 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 work flow 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.

Education and Experience Requirements

  • Must be a high school graduate, Associate's or Bachelor's degree in a Healthcare related field preferred. 

  • 4 years experience in a medical billing setting with exposure to denials, appeals, insurance collections, and related follow-up

  • Good knowledge of ICD-9 and CPT-4 coding,

  • Good working knowledge with insurance EOB's and comprehensive understanding of remittance and remark codes required. 

  • Must be familiar with multiple payer requirements for claims processing and possess solid skills with Microsoft office products especially

  • MS Word and MS Excel.