Patient Financial Services Denials and Appeals Specialist

Prisma Health

Denials and Appeals Specialist ensuring timely resolution of denied accounts within healthcare revenue cycle. Responding to denial trends and managing claims follow-up efficiently.

Posted 4/22/2026full-timeRemote • Tennessee • 🇺🇸 United StatesMid-LevelSeniorWebsite

About the role

Key responsibilities & impact

Responsible for pursuing denied accounts, timely and accurate follow-up to address and improve resolution of payment delays
Updating/reprocessing claims, submitting reconsiderations/appeals within proper filing timeframe to achieve optimal payment for services rendered
Monitors denial work queues and reports in accordance with assignments from direct supervisor
Communicates all denial trends, denial increases, etc. to direct supervisor/PFS management
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 related tasks to identify patterns and/or work most efficiently
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
Works with other departments to resolve A/R and payer issues
Enters and documents appropriate accounts for adjustments utilizing the appropriate adjustment codes
Identifies and researches all 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

Requirements

What you’ll need

High School diploma or equivalent
Five (5) years hospital/physician billing office and/or healthcare revenue cycle experience
Certified Revenue Cycle Analyst (CRCA) preferred
Proficient computer skills (spreadsheets and excel pivot table skills)
Data entry skills
Mathematical skills
Medical terminology/ICD Coding Knowledge of current 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
Ability to review/understand all pertinent information such as insurance carrier explanation of benefits, insurance carrier 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

Benefits

Comp & perks

Health insurance
Retirement plans
Paid time off
Flexible work arrangements
Professional development

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

hospital billingphysician billinghealthcare revenue cycledata entrymathematical skillsICD codingremittance codesremark codespayer editsUB-04 claim forms

Soft Skills

self-motivationinitiativetime managementorganizational skillscommunicationproblem-solvinganalytical skillsattention to detailteam collaborationpattern identification

Certifications

Certified Revenue Cycle Analyst (CRCA)