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Job ID: 50879
Location: Smithfield, NC
Facility/Division: Johnston Health
Status: Full Time
Shift: Day Job
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.
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.
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.
● High School diploma or GED
● 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:
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.
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity and affirmative action employer.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
All interested applicants are invited to apply for career opportunities. Please refer to our Employment Application Accessibility page if you need a reasonable accommodation to search and/or to apply for a career opportunity.
To verify employment eligibility, UNC Health is committed to Form I-9 and the E-Verify process.