Patient Financial Services Denials and Appeals Specialist, FT, Days, - Remote

Prisma Health
United States, South Carolina, Greenville
300 East McBee Avenue (Show on map)
Feb 28, 2025
Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for the coordination and resolution of the administrative denials and appeals of the system-wide comprehensive denials and appeals management program. Performs the necessary audits to evaluate the revenue cycle process and educates Management Staff on issues impacting reimbursement. This is a remote position. Accountabilities Utilizing the Prisma Health information systems, identifies and resolves a minimum of 40 accounts per day that have been improperly denied by insurance carriers for administrative reasons. All new business must be worked within one day and corrective action claims to be worked and followed up within two days of request. This includes researching denied claims, collaborating with departments, processing appeals, and resolving the denial for appropriate payments as defined in Prisma Health Denial Management Procedures. Facilitates the identification and resolution of in-house denials and appeals through effective collaboration with the Utilization Review/Outcomes Management Department. Represents Prisma Health when interacting with payors regarding administrative denial issues. Monitors denial and appeals information for payor, provider or departmental trends. Routinely reports to management regarding trends and recommends process improvement initiatives. Regularly reviews aging appeals and problem cases. Produces denials and appeals tracking reports for Management and departments. Provides comprehensive training for Prisma Health staff regarding denial resolution, appeals processing, process improvement, and revenue cycle issues that impact reimbursement. Assists the Manager of Denials and Appeals Management and the Director of Reimbursement with the development of strategic goals relative to the reduction in denials volume. Maintains knowledge of current trends and developments in the healthcare industry and specifically as it relates to denials and appeals through appropriate literature and professional development activities. Supervisory/Management Responsibility This is a non-management job that will report to a supervisor, manager, director, or executive. Minimum Requirements High School diploma or equivalent 5 years of healthcare revenue cycle experience. (Denials and appeals management experience preferred.) Required Certifications/Registrations/Licenses N/A In Lieu Of The Above Minimum Requirements Bachelor's Degree in business management, finance, accounting or other related field would substitute for three of the five years of required experience. Other Required Skills and Experience Excellent Microsoft Office Skills, including the use of pivot tables in Excel Superior written and oral communication skills Work Shift Day (United States of America) Location Patewood Outpt Ctr/Med Offices Facility 7001 Corporate Department 70019012 Patient Account Services Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.