Patient Financial Services Denials & Appeals Specialist

This is a fully remote position, open to applicants in South Carolina.

📋 Description

• Accountable for pursuing denied accounts.

• Ensure timely and precise follow-up to enhance resolution of payment delays.

• Update and reprocess claims as necessary.

• Submit reconsiderations and appeals within the appropriate filing timeframe to secure optimal payment for services provided.

• Oversee denial work queues and generate reports.

• Report all trends in denials and increases in denials to the direct supervisor/PFS management.

• Maintain required productivity and quality levels while handling tasks in work queues.

• Identify and track negative trends in denials and rejections.

⛳️ Requirements

• High School diploma or equivalent, or post-high school diploma / highest degree attained.

• A minimum of five (5) years of experience in a hospital or physician billing office and/or healthcare revenue cycle.

• Certified Revenue Cycle Analyst (CRCA) designation preferred.

• Proficient in computer skills, including spreadsheets and Excel pivot tables.

• Strong data entry capabilities.

• Solid mathematical skills.

• Knowledge of medical terminology and ICD coding.

• Ability to review and comprehend all relevant information, such as insurance carrier explanation of benefits, denial letters, and electronic remits.

• Thorough understanding of remittance and remark codes.

• Familiarity with payer edits, rejections, rules, and appropriate responses to each.

🏝️ Benefits

• Health insurance coverage.

• Opportunities for professional development.

• Flexible work arrangements available.