PB - A / R Denials and Appeals Specialist, FT, Days

Inspire health. Serve with compassion. Be the difference.

Job Summary

Analyzes trends specific to denials, root cause, and accounts receivable impact. Resolves account issues or escalates as needed and documents billing activity on the patient accounts according to departmental and regulatory guidelines.

This is a remote position.

Essential Functions

All team members are expected to be knowledgeable and compliant with Prisma Health's values : Inspire health. Serve with compassion. Be the difference.

Analyzes and articulates trends specific to denials, root cause, and A / R impact

Completes and submits claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines and timeliness standards

Contacts payer for inquiries on account status. Escalates account issues as needed and initiates the appeal process. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders.

Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis

Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance. Ensures all work is compliant with privacy, HIPAA, and regulatory requirements

Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross trained and proficient operate in any of these roles if the need arises.

Performs other duties as required.

Supervisory / Management Responsibilities

This is a non-management job that will report to a supervisor, manager, director or executive.

Minimum Requirements

Education - High School diploma or equivalent OR post-high school diploma / highest degree earned

Experience - Two (2) years billing, bookkeeping, accounting experience

In Lieu Of

NA

Required Certifications, Registrations, Licenses

NA

Knowledge, Skills, and Abilities

Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist.

Work Shift

Day (United States of America)

Location

Corporate

Facility

7001 Corporate

Department

70019122 PBO-Patient Account Services

Share your talent with us! Our vision is simple : to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.