Denials Management Specialist

Spartanburg Regional Medical Center Spartanburg , SC 29306

Posted 2 months ago

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, plus 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.

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, plus 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.


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Denials Management Specialist

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