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Patient Financial Services Denials and Appeals Specialist
Prisma HealthDenials and Appeals Specialist at Prisma Health managing denied accounts and improving payment resolutions. Responsible for timely claim follow-up, organization, and compliance with billing regulations.
About the role
Key responsibilities & impact- Responsible for pursuing denied accounts and timely follow-up to address payment delays.
- Updating/reprocessing claims and submitting reconsiderations/appeals within proper filing timeframe.
- Knowledgeable of payer requirements and experienced in claim resolution.
- Identifying, expediting, and escalating trends to management.
- Demonstrating exceptional relationships with external/internal payers and internal departments.
- Monitoring denial work queues and reporting in accordance with assignments from direct supervisor.
- Participating in departmental huddles and team meetings involving discussion of A/R processes and denial trends.
- Maintaining required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals.
- Organizing denial/rejection related tasks to identify patterns or work efficiently (e.g., by current procedural terminology, diagnosis, payer, etc.).
- Identifying and monitoring negative patterns in denials/rejections and escalating accordingly to PFS management.
- Utilizing identified and known resources to accomplish follow-up on tasks.
- Complying with all government regulatory mandated requirements for billing and collections.
Requirements
What you’ll need- High School diploma or equivalent or post-high school diploma / highest degree earned.
- 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- Inspire health.
- Serve with compassion.
- Be the difference.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claim resolutiondata entrymathematical skillsmedical terminologyICD codingremittance codesremark codespayer editsUB-04 claim formsspreadsheets
Soft Skills
self-motivationinitiativetime managementorganizational capabilitiesrelationship buildingproblem-solvingcommunicationteam collaborationattention to detailpattern identification
Certifications
Certified Revenue Cycle Analyst