PB- Denials and Appeals Specialist, FT, Days
- Full-time
Inspire health. Serve with compassion. Be the difference.
Job Summary
Analyzes trends specific to denials, root cause, and accounts receivable impact. Resolves account issues or escalates as needed and documents billing activity on the patient accounts according to departmental and regulatory guidelines.
This is a remote position
Essential Functions
All team members are expected to be knowledgeable and compliant with Prisma Health's values : Inspire health. Serve with compassion. Be the difference.
Analyzes and articulates trends specific to denials, root cause, and A / R impact
Completes and submits claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines and timeliness standards
Contacts payer for inquiries on account status. Escalates account issues as needed and initiates the appeal process. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders.
Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis
Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance. Ensures all work is compliant with privacy, HIPAA, and regulatory requirements
Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross trained and proficient operate in any of these roles if the need arises.
Performs other duties as required.
Supervisory / Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
Education - High School diploma or equivalent OR post-high school diploma / highest degree earned
Experience - Two (2) years billing, bookkeeping, accounting experience
In Lieu Of
NA
Required Certifications, Registrations, Licenses
NA
Knowledge, Skills, and Abilities
Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist.
Work Shift
Day (United States of America)
Location
Independence Pointe
Facility
7001 Corporate
Department
70019122 PBO - Correspondence
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.
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