What are the responsibilities and job description for the Specialist-Denials Management position at Spartanburg Regional Healthcare System?
Job Requirements
Position Summary
The Denial Management Specialist is responsible for denial and AR management for the department as defined by their supervisor/manager.
Minimum Requirements
Education
- High School Diploma or equivalency
Experience
- 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
License/Registration/Certifications
- N/A
Preferred Requirements
Preferred Education
- Associates or Bachelor's degree in a Healthcare related field.
Preferred Experience
- Focused denials and appeals management experience.
Preferred License/Registration/Certifications
- 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.
