What are the responsibilities and job description for the Denial Specialist position at Hampton Regional Medical Center?
Denial Specialist
Hampton Regional is seeking a detail-oriented and experienced Insurance Denial Specialist to join our Revenue Cycle team. This position is responsible for reviewing, analyzing, and appealing denied insurance claims to ensure maximum reimbursement for hospital services. The ideal candidate will have a strong understanding of payer policies, coding regulations, and healthcare billing processes.
Key Responsibilities:
Review and analyze denied or underpaid insurance claims to determine appropriate follow-up actions.
Research root causes of denials and work collaboratively with billing, coding, and clinical departments to resolve issues.
Prepare and submit appeal letters and documentation to insurance carriers in a timely and accurate manner.
Monitor appeal status and communicate regularly with payers to ensure resolution.
Identify trends in denials and recommend process improvements to reduce future occurrences.
Maintain accurate records of denial and appeal activity within the system.
Ensure compliance with federal, state, and payer-specific regulations and guidelines.
Communicate with patients and providers when additional documentation is needed.
Meet established productivity and quality standards.
Qualifications:
Education: High school diploma or GED required
Experience: Minimum of 2 years of experience in insurance billing, claims processing, or denial management within a hospital or healthcare environment.
Skills:
Strong knowledge of medical billing and coding (ICD-10, CPT, HCPCS)
Familiarity with insurance policies and regulations (Medicare, Medicaid, Commercial Payers)
Excellent communication, analytical, and organizational skills
Proficient in EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite
Ability to work independently and manage multiple priorities
Standard office environment within a hospital setting.
Competitive Salary with excellent benefits!
Additional Information
Position Type : Full Time
Contact Information
Lynn Bowers - Human Resources Director
Hampton Regional Medical Center
595 Carolina Ave W.
Varnville, SC 29944
Email: lbowers@hamptonregional.org
Phone: 803-943-1252
ICD-10, CPT, HCPCS EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite
Key Responsibilities:
Qualifications:
Education: High school diploma or GED required
Experience: Minimum of 2 years of experience in insurance billing, claims processing, or denial management within a hospital or healthcare environment.
Skills:
Strong knowledge of medical billing and coding (ICD-10, CPT, HCPCS)
Familiarity with insurance policies and regulations (Medicare, Medicaid, Commercial Payers)
Excellent communication, analytical, and organizational skills
Proficient in EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite
Ability to work independently and manage multiple priorities
Standard office environment within a hospital setting.
Competitive Salary with excellent benefits!
Additional Information
Position Type : Full Time
Contact Information
Lynn Bowers - Human Resources Director
Hampton Regional Medical Center
595 Carolina Ave W.
Varnville, SC 29944
Email: lbowers@hamptonregional.org
Phone: 803-943-1252
ICD-10, CPT, HCPCS EHR systems (e.g., Epic, Cerner) and Microsoft Office Suite
