Patient Financial Services Denials & Appeals Specialist

Role Overview

• 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
• Monitor denial work queues and reports
• Communicate all denial trends, denial increases to direct supervisor/PFS management
• Maintain required levels of productivity and quality while managing tasks in work queues
• Identify and monitor negative patterns in denials/rejections

Requirements

• 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
• Ability to review/understand all pertinent information such as insurance carrier explanation of benefits, insurance carrier denial letters and electronic remits
• Comprehensive understanding of remittance and remark codes
• Knowledge of payer edits, rejections, rules, and how to appropriately respond to each

Benefits

• Health insurance
• Professional development
• Flexible work arrangements