PB Denials Specialist

2 days ago


Columbia, South Carolina, United States Prisma Health Full time
Job Summary

This is a remote position that requires strong analytical and communication skills. The successful candidate will be responsible for analyzing and articulating trends related to denials, root cause, and A/R impact.

Key Responsibilities
  • Analyze and articulate trends related to denials, root cause, and A/R impact
  • Complete and submit claims via electronic or paper claim submission according to governmental regulations, agency policies, and Prisma Health guidelines
  • Contact payers and make hard inquiries on account status, escalating problem accounts and initiating the appeal process
  • Document billing activity on patient accounts according to departmental guidelines, ensuring compliance with all applicable billing regulations and reporting any suspected compliance issues to departmental leaders
  • Ensure all work is compliant with privacy, HIPAA, and regulatory requirements
  • Participate in general or special assignments and attend all required training
  • Adhere to policies and procedures as required by Prisma Health and follow all compliant regulatory payer guidance
  • Be knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist, and be cross-trained and proficient in operating in any of these roles if the need arises
Requirements
  • High School diploma or equivalent OR post-high school diploma/highest degree earned
  • 2 years of experience in billing, bookkeeping, or accounting
About Prisma Health

Our vision is simple: to transform healthcare for the benefit of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.


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