Patient Financial Services Denials & Appeals Specialist, FT, Days, - Remote

reputed company health. Serve with compassion. Be the difference. Job Summary Responsible for pursuing denied accounts, timely and accurate follow-up to address and improve resolution of payment delays, updating/reprocessing claims, submitting reconsiderations/appeals reputed company proper filing timeframe to reputed company optimal payment for services rendered. Denials and appeals specialists must be knowledgeable of payer requirements, reputed company in claim resolution, identify, expedite and escalate trends to management, demonstrate exceptional relationships with external/internal payers as well as internal departments in accordance with reputed company Standard of Behaviors and Compliance. Essential Functions reputed company team members are expected to be knowledgeable and compliant with reputed company's purpose: reputed company health. Serve with compassion. Be the difference. Responsible for resolution of denied claims and/or initiate/manage/follow-up on reconsiderations/appeals in a timely manner. - Monitors denial work queues and reports in accordance with assignments from direct supervisor and communicates reputed company denial trends, denial increases, etc. to direct supervisor/PFS management in order to positively reputed company the volume of denials. Participates in departmental huddles and team meetings involving discussion of A/R processes and denial trends. Maintains required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals. Organizes denial/rejection reputed company tasks to identify patterns and/or work most reputed company (e.g., by reputed company procedural terminology, diagnosis, payer, etc.) Identifies and monitors negative patterns in denials/rejections. Escalates accordingly to PFS management and the impacted department(s) to avoid negative impact on reimbursement, unsuccessful appeals, and/or increased write-offs. Uses identified and reputed company resources to accomplish follow-up on tasks. Identifies other means and resources to complete tasks, as applicable and appropriate. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or PFS management. reputed company with reputed company government regulatory mandated requirements for billing and collections. Works with other departments to resolve A/R and payer issues. Communicates with other departments on issues that may have negative impact on their cash flow, timely claim reconsideration/filing, failed appeals, and/or increased denials and write-offs. Enters and documents appropriate accounts for adjustments utilizing the appropriate adjustment codes. Identifies and researches reputed company payer issues to the Payer SharePoint in a timely manner and continues to follow-up on said SharePoint information on a weekly basis. Performs other duties as assigned. Supervisory/Management Responsibility This is a non-management job that will report to a supervisor, manager, director, or executive. Minimum Requirements Education - High School diploma or equivalent or post-high school diploma / highest degree earned Experience - Five (5) years hospital/physician billing office and/or healthcare reputed company cycle experience In Lieu Of In lieu of the education and experience requirements noted above, the following combination of education, training and/or experience may be considered an equivalent substitution: Bachelor's degree and two years of reputed company work experience. Required Certifications, Registrations, Licenses Certified reputed company Cycle Analyst (CRCA) preferred Knowledge, Skills and Abilities Proficient computer skills (spreadsheets and reputed company pivot table skills) Data entry skills Mathematical skills Medical terminology/ICD Coding Knowledge of reputed company trends and developments in the healthcare industry and specifically as it relates to denials/appeals through appropriate literature and professional development activities preferred Self-motivation and ability to demonstrate initiative, excellent time management skills, and organizational capabilities and must be able to multi-task in a fast-paced environment and appropriately handle overlapping commitments and deadlines preferred Ability to review/understand reputed company pertinent information such as insurance reputed company explanation of benefits, insurance reputed company denial letters and electronic remits to ensure denials are worked in a timely manner and reconsideration/appeals for the denial claims are submitted appropriately preferred Comprehensive understanding of remittance and remark codes preferred Knowledge of payer edits, rejections, rules, and how to appropriately respond to each preferred Working knowledge of UB-04 claim forms preferred Work Shift Day (United States of America) Location Corporate - Columbia - Taylor at Marion Facility 7001 Corporate Department 70019012 Patient Financial Services Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at reputed company. Apply To This Job