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Denial Analyst

2 months ago

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

We are seeking a highly skilled and detail-oriented individual to join our team as a Denial Analyst. In this role, you will be responsible for analyzing and articulating trends specific to denials, root cause, and A/R impact.

Key Responsibilities
  • Analyze and articulate trends specific to denials, root cause, and A/R impact (25%)
  • Complete and submit claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines, and timeliness standards (10%)
  • Contact payers and make hard inquiries on account status. Escalate problem accounts and initiate the appeal process. Document billing activity on patient accounts according to departmental guidelines; ensure compliance with all applicable billing regulations and report any suspected compliance issues to departmental leaders (25%)
  • Ensure all work is compliant with privacy, HIPAA, and regulatory requirements (10%)
  • Participate in general or special assignments and attend all required training (10%)
  • Adhere to policies and procedures as required by Prisma Health and follow all compliant regulatory payer guidance (10%)
  • Be knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Be cross-trained and proficient in operating in any of these roles if the need arises (10%)
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 benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.