You haven't searched anything yet.
Kent Campus Hospital
STATUS: Full Time 80 Hours
SHIFT: Days
GENERAL SUMMARY:
Summary:
The specialist is responsible for reviewing and processing of charges as well as researching and appealing denied claims. The Specialist must effectively interact with multiple disciplines including Patient Access, Hospital Information Management, Contract management, patient Financial Services, physicians, private insurance and government agencies. The Specialist demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to physician office services.
ESSENTIAL FUNCTIONS & ACCOUNTABILITIES:
1. Review and process charges to help ensure clean claims and invoices. Contact providers and clinical staff with any questions to process charges correctly.
2. Work follow-up work queues to process denials on a daily basis, resubmitting claims and writing appeals as appropriate based on the denial. Completion of necessary payer reconsideration forms. Recording of identified issues into payer issue logs/spreadsheets.
3. Timely follow-up/communication with payer on appeals submitted until a final resolution has been reached.
4. Monitor and track submitted appeals; monitors reduction of denial volume and reduction of backlog of non-reconciled denials.
5. Based on the nature of the denials, determine potential root causes, flag/track repetitive issues and communicate progress to management on a monthly basis. Identification of departmental process/procedure improvements and/or education as needed to address prospective denials avoidance.
6. Strong working knowledge of payer contracts and Federal program claim submission guidelines.
7. Perform registration and scheduling duties to be able to participate in process improvement on a routine basis.
8. Perform cash posting and reconciliation for Occupational Health.
9. All other duties as assigned within the scope and range of job responsibilities
REQUIRED MINIMUM EDUCATION AND CREDENTIAL:
EXPERIENCE:
Required: Four years hospital/physician office patient Accounting including billing, collections, ins authorization and A/R Preferred: Five years hospital/physician office billing or collections experience. Prior written clinical appeal experience.
PREFERRED EDUCATION AND CREDENTIAL:
To view a full list of all open position at Bayhealth, please visit:
https://apply.bayhealth.org/join/
Full Time
Ancillary Healthcare
$47k-58k (estimate)
03/30/2023
05/14/2024
bayhealthdevelopment.com
EMERYVILLE, CA
<25
2015
<$5M
Ancillary Healthcare
BayHealth is a UCSF Health and John Muir Health joint venture company focused on infrastructure development supporting the needs of the Canopy Health accountable care network, and serving as a joint strategic investment vehicle in support of the UCSF/JMH affiliation. We are deeply committed to value creation in the Canopy Health network and our shared vision with UCSF/JMH for innovation in patient experience, access, affordability and quality of care.
The job skills required for Denials And Appeals Specialist include Billing, Scheduling, etc. Having related job skills and expertise will give you an advantage when applying to be a Denials And Appeals Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Denials And Appeals Specialist. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Denials And Appeals Specialist positions, which can be used as a reference in future career path planning. As a Denials And Appeals Specialist, it can be promoted into senior positions as an Appeal Resolution Senior Specialist that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Denials And Appeals Specialist. You can explore the career advancement for a Denials And Appeals Specialist below and select your interested title to get hiring information.