Spartanburg Regional Healthcare System Denials Management Specialist in Spartanburg, South Carolina
The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.
- High School Diploma or equivalency
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
- Associates or Bachelor’s degree in a Healthcare related field.
- Focused denials and appeals management experience.
- 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.