Remote Denials Management Specialist

Spartanburg Regional Healthcare System - Spartanburg, SC

Full-time

Remote - Spartanburg, SC

5,001-10,000 employees

Nursing and Residential Care Facilities

About the position

The Denials Management Specialist position is a fully remote role focused on denial and accounts receivable (AR) management within the Business Services department. This position is critical in ensuring that all outstanding denials are researched and resolved efficiently, adhering to departmental policies and standards. The specialist will be responsible for managing the denial workflow, which includes identifying denial trends, initiating and managing insurance appeals, and communicating effectively with supervisors regarding denial increases. The role requires a comprehensive understanding of medical billing processes, particularly in relation to denials, appeals, and insurance collections. The specialist will work closely with various stakeholders to ensure timely follow-up on denials and will be expected to prepare for and attend AR denial meetings as required. This position also involves completing special projects assigned by the supervisor or manager, which may vary in scope and complexity. The ideal candidate will possess strong analytical skills to identify trends and provide education on preventing future denials, as well as solid communication skills to convey important information to the management team. This role is essential for maintaining the financial health of the organization by effectively managing denials and ensuring that all necessary follow-up actions are taken promptly. The position requires a proactive approach to problem-solving and a commitment to excellence in service delivery.

Responsibilities

• Research and resolve all outstanding denials within the work queue 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 procedures to ensure timeliness and accuracy of response.
• Complete special projects as assigned by Supervisor/Manager.
• Prepare/attend AR denial meetings as required.

Requirements

• High School Diploma or equivalency.
• 4 years' experience in medical billing, with exposure to denials, appeals, insurance collections, and related follow-up.
• Good knowledge of ICD9 and CPT-4 coding.
• Good working knowledge of insurance explanation of benefits (EOB) and a 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 communication skills.

Nice-to-haves

• Associates or Bachelor's degree in a Healthcare related field.
• Focused denials and appeals management experience.
• CPC and/or CPC-H certification.