PB Denials Specialist
2 days ago
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
- High School diploma or equivalent OR post-high school diploma/highest degree earned
- 2 years of experience in billing, bookkeeping, or accounting
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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