Denial Specialist
Medical University of South Carolina, Columbia, South Carolina, United States
Overview
Job Description Summary
The denial specialist will analyze and research claim authorization denials and determine the appropriate course of action including but not limited to filing appeals and/or filing adjustments. Document and monitor the status of appeal claims and follow up with payor representatives as needed to expedite resolution. Identify denial trends, root causes and make recommendations for process improvement. Ensure legal compliance by following company policies, procedures, guidelines, and as well as federal insurance regulations.
Details Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005031 SYS - Revenue Cycle Middleware
Pay Rate Type
Hourly
Pay Grade
Health-20
Scheduled Weekly Hours
40
Work Shift
Job Description
The denial specialist will analyze and research claim authorization denials and determine the appropriate course of action including but not limited to filing appeals and/or filing adjustments. Document and monitor the status of appeal claims and follow up with payor representatives as needed to expedite resolution. Identify denial trends, root causes and make recommendations for process improvement. Ensure legal compliance by following company policies, procedures, guidelines, and as well as federal insurance regulations.
Qualifications Additional Job Description
High School Diploma Required
1-3 years experience in healthcare billing and insurance follow-up.
Experience in claim appeals and appeal follow up
• Clear and concise communication skills; ability to work with payors and internal teams.
• Proactive problem solving and process improvement mindset.
All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Compliance & Equal Opportunity The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please visit the official USCIS E-Verify website: http://www.uscis.gov/e-verify/employees
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Details Entity
Medical University Hospital Authority (MUHA)
Worker Type
Employee
Worker Sub-Type
Regular
Cost Center
CC005031 SYS - Revenue Cycle Middleware
Pay Rate Type
Hourly
Pay Grade
Health-20
Scheduled Weekly Hours
40
Work Shift
Job Description
The denial specialist will analyze and research claim authorization denials and determine the appropriate course of action including but not limited to filing appeals and/or filing adjustments. Document and monitor the status of appeal claims and follow up with payor representatives as needed to expedite resolution. Identify denial trends, root causes and make recommendations for process improvement. Ensure legal compliance by following company policies, procedures, guidelines, and as well as federal insurance regulations.
Qualifications Additional Job Description
High School Diploma Required
1-3 years experience in healthcare billing and insurance follow-up.
Experience in claim appeals and appeal follow up
• Clear and concise communication skills; ability to work with payors and internal teams.
• Proactive problem solving and process improvement mindset.
All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.
Compliance & Equal Opportunity The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations.
Medical University of South Carolina participates in the federal E-Verify program to confirm the identity and employment authorization of all newly hired employees. For further information about the E-Verify program, please visit the official USCIS E-Verify website: http://www.uscis.gov/e-verify/employees
#J-18808-Ljbffr