Medical Denial Specialist

Overview

IMMEDIATE opening in Greenville for Medical Denial Specialists. We are seeking proactive problem solvers with time management skills that are interested in joining a great team and growing practice. Medical billing experience is required with Epic experience preferred. We will train to ADD TO YOUR current medical billing skills / experience! COME LEARN AND GROW WITH US!

Job Title : Medical Denial Specialist

Job Type : Full time

Location : 203 Mills Avenue Greenville, SC 29605 (this is an in-person position)

Practice Overview : We are a growing medical practice with 9 office locations across the upstate. Our providers care for patients at 21 dialysis locations and multiple hospitals as well.

Job Description

The Denial Specialist is responsible for working denials that are categorized by payer / place of service in various work queues. This includes, but is not limited to, investigating specific denial categories and codes, finding the underlying reason for the denial, correcting the issue and rebilling the claim to ensure that we are properly reimbursed. Overpayment letters from payers that are sent by mail will also be part of this job description. Demonstrate a high level of expertise in the management of denied claims and deploy an analytical approach to resolving denials while recognizing trends and patterns in order to proactively resolve recurring issues. Communicate identified denial patterns to management. Prioritize and process denials while maintaining high quality of work. Serve as an escalation point for unresolved denial issues. Inform team members of payer policy changes. Collaborate on special projects as needed. Assist manager of additional tasks as needed.

Working as a team which includes, but is not limited to, answering incoming phone calls, assisting patients with billing questions, and helping one another when needed.

Responsibilities

Claims

• Appealing denied claims, including researching underlying root cause, collecting required information, adjusting the account as necessary, resubmitting claims to avoid past timely filing guidelines, and all appropriate follow up activities to ensure adjudication of the claim.
• Contacting payers via portals or phone to work the denial efficiently.
• Following up on outstanding claims.
• Insurance verification via portals when appropriate.
• Issuing / requesting payer refunds when appropriate

Patient Interactions

Phone calls or mailing patient letters :

Overpayment Letters - Payers requesting refunds due to various reasons.

Benefits

Expected Schedule

Requirements

Essential Requirements

Preferred Skills

All offers of employment at Carolina Nephrology, PA are contingent upon clear results of a thorough background check. Background checks will be conducted on all final candidates and on all employees who are promoted, as deemed necessary.

Background checks will include :

Procedure

Final candidates must complete a background check authorization form and return it to Human Resources.

Human Resources will order the background check upon receipt of the signed release form, and either internal HR staff or an employment screening service will conduct the checks. A designated HR representative will review all results.

The HR representative will notify the hiring manager regarding the results of the check. In instances where negative or incomplete information is obtained, the appropriate management and the director of Human Resources will assess the potential risks and liabilities related to the job's requirements and determine whether the individual should be hired. If a decision not to hire or promote a candidate is made based on the results of a background check, there may be certain additional Fair Credit Reporting Act (FCRA) requirements that will be handled by Human Resources in conjunction with the employment screening service (if applicable).

Background check information will be maintained in a file separate from employees' personnel files for a minimum of five years.

Carolina Nephrology, PA reserves the right to modify this policy at any time without notice.

Salary : $16 - $21