Denials & Appeals Specialist - Central Business Office (CBO) Management

ECU Health
About ECU Health
ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations.

The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Childrens Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Position Summary
The Denials & Appeals Specialist is responsible for appealing denied claims. As a Denials & Appeals Specialist, you will effectively interact with multiple disciplines including Clinical Service Areas, Hospital Information Management, Charge Description Master, Corporate Compliance, private insurance and government agencies. Must demonstrate self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to hospital services.

As a Denials & Appeals Specialist, You Will

• Maintain working knowledge of payer rules, regulations and contracts so that appeals are filed timely and accurately to recover payment
• Review medical documentation in order to prepare appeals and related filings to support medical necessity of services
• Collaborate with clinical service areas as needed to develop appeals and/or help reduce denials due to lack of documentation
• Manage appeals on a daily basis that are housed in multiple denial work queues that are subject to mix levels of priorities / deadlines.
• Comprehensive decision logic and analysis skills
• Maintain confidentiality and comply with HIPAA and fraud and abuse policies and procedures
• Review claim denials from Third Party Payers and file appeals to recover payment for denied services for ECU Health Hospitals and Surgicenter

Minimum Requirements

• Associate degree (or higher) in Business, Healthcare Administration, Health Information Management or related. A clinical degree (LPN, ADN or BSN) also meets the requirement.
• 2+ years experience with clinical denials and appeals for hospital billing is required.

Preferred

• 3 to 5 years of experience in Revenue Cycle Operations.
• Coding Certification (ex. CCSP, RHIT)
• Excellent grammar, written and oral communication skills. Working knowledge of Microsoft Excel and Word & basic typing ability.

Other Information

• 40 hours per week
• Remote role (based out of Greenville, NC)

• Monday - Friday day shift:

• 8:00 a.m. - 5:00 p.m.

• Great Benefits

General Statement
It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.