Denials and Appeals Specialist

Overview

This position is a reimbursement specialist/payment recovery specialist position. This position is responsible for identifying underpayments, specifically denials or reductions, and working with the payers to recover the reimbursement. This will include working with the hospital's billing system and audit software and also the hospitals managed care contracts. This position also has to work with various departments within the organization, such as ancillary departments and the coding and billing department to troubleshoot and identify root cause variances in order to prevent future losses in reimbursement. These variances should be communicated via daily interaction and monthly status meetings with department manager. The Patient Financial Services Level I services multiple hospital facilities and reports to the Patient Financial Services Supervisor/Manager.

The qualified candidate will possess the following:
 

A. Education:

1. High school diploma or GED from an accredited institute is required. Associate's degree or some college coursework from an accredited college or university preferred.

B. Experience:

1. Two years of experience in healthcare billing, coding, collections, payment processing, or denials management. Denials management experience preferred.

C. Licensure/Certifications:

1. Professional Certifications related to Coding, Billing, Accounting, Patient Representative, or other related field preferred.