Job ID: 949523
Facility: Vidant Health
Location: Greenville, NC
Date Posted: Mar 22, 2021
About Vidant Health
Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.
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.
1. Review claim denials from Third Party Payers and file appeals to recover payment for denied services for Vidant Health Hospitals and Surgicenter
2. Maintain working knowledge of payer rules, regulations and contracts so that appeals are filed timely and accurately to recover payment
3. Review medical documentation in order to prepare appeals and related filings to support medical necessity of services
4. Collaborate with clinical service areas as needed to develop appeals and/or help reduce denials due to lack of documentation
5. Manage appeals on a daily basis that are housed in multiple denial work queues that are subject to mix levels of priorties / deadlines.
6.Comprehensive decision logic and analysis skills
7.Maintain confidentiality and comply with HIPAA and fraud and abuse policies and procedures
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.