Denial Specialist

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:
The Denial Specialist is responsible in the timely and appropriate validation and follow up of denied claims. They thoroughly investigate denied claims and address them by assigning the appropriate resources with the denial management process.

Responsibilities:

1. Analyzes denials and appeals pattern for trends. Provides information to leadership regarding patterns or trends (practitioners, diagnosis, patient location) associated with appeals.
2. Assigns expected value (payment) of care. Acts as a resource to staff relative to concurrent and retrospective denials of payment and services relative to the appeal process.
3. Attends appeal hearings as appropriate to represent the institution. Appeals denials based on medical necessity. Completes all necessary paperwork.
4. Notes due date for research and completion. Updates HIS status of denial.
5. Participates with Managed Care Department in reviewing payor contracts to assess the feasibility of the reviews being requested. Concurrent problem solving and prevention of pending denials in collaboration with care managers. Extracts from the medical record clinically pertinent information to respond to demands and develop concise action steps based on payor letter codes reason for denial.

Other Information

Other information:
Education Requirements:
● High School diploma or GED
Licensure/Certification Requirements:
● No licensure or certification required.
Professional Experience Requirements:
● Three (3) years of experience in a clerical, accounting or customer service setting or an equivalent combination of education, training and experience
Knowledge/Skills/and Abilities Requirements:

Job Details

Legal Employer: NCHEALTH

Entity: Johnston Health

Organization Unit: Business Office

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Schedule: Day Job

Location of Job: US:NC:Smithfield

Exempt From Overtime: Exempt: No

This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.

Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.