Denials & Appeals Specialist - Greenville, NC

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941351

Vidant Health

Full-Time

Regular

Vidant Health

About Vidant Medical Center

Vidant Medical Center is a 900+ bed Level-1 Trauma Center, regional referral hospital and is the flagship hospital for Vidant Health. We serve as the teaching hospital for the Brody School of Medicine at East Carolina University. Vidant Medical Center provides acute, intermediate, rehabilitation and outpatient services to more than 1.4 million people in 29 counties. But it's in our work environment that you'll find our sense of family and closeness that permeates everything we do.

 

Position Summary

The Denials & Appeals Specialist is responsible for appealing denied claims. The position must effectively interact with multiple disciplines including Clinical Service Areas, Hospital Information Management, Charge Description Master, Corporate Compliance, private insurance and government agencies. The denials and appeals specialist demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to hospital services.

Responsibilities

  • Review  claim denials from  Third Party Payers and file appeals to recover payment for denied services for Vidant Health Hospitals and Surgicenter
  • Maintain working knowledge of payer rules, regulations and contracts so that appeals are filed timely and accurately to recover payment
  • Review medical documentation in order to prepare appeals and related filings to support medical necessity of services
  • Collaborate with  clinical service areas as needed to develop appeals and/or help reduce denials due to lack of documentation
  • Manage appeals on a daily basis that are housed in multiple denial work queues that are subject to mix levels of priorties / deadlines.
  • Comprehensive decision logic and analysis skills
  • Maintain confidentiality and comply with HIPAA and fraud and abuse policies and procedures
  • 3 to 5 years of expiernece in Revenue Cycle Operations - Preferred
  • Excellent grammar, written and oral communication skills - Preferred
  • Working knowledge of Microsoft Excel and Word & basic typing ability - Preferred
  • RHIT - Preferred
  • CCSP or AHIMA

Other Information

 JOBS@VIDANTHEALTH.COM

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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