Patient Financial Services Denials & Appeals Specialist

🕒 3 days ago

🌴 South Carolina – Remote

🌴 South Carolina – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

💸 Financial Planning and Analysis (FP&A)

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Prisma Health

WebsiteLinkedInAll Job Openings

10,000+ employees

⚕️ Healthcare Insurance

Healthcare Insurance

Prisma Health is a comprehensive health care provider offering a wide range of medical services to ensure individuals achieve their healthiest state. With numerous locations, advanced technology, and expert specialists, Prisma Health provides accessible and convenient care. Services include primary care, specialized heart, cancer, women's, and children's health, as well as same-day and telehealth options. Prisma Health emphasizes community outreach and education to support overall health and wellness.

📋 Description

• Responsible for pursuing denied accounts • Timely and accurate follow-up to address and improve resolution of payment delays • Updating/reprocessing claims • Submitting reconsiderations/appeals within proper filing timeframe to achieve optimal payment for services rendered • Monitor denial work queues and reports • Communicate all denial trends, denial increases to direct supervisor/PFS management • Maintain required levels of productivity and quality while managing tasks in work queues • Identify and monitor negative patterns in denials/rejections

🎯 Requirements

• High School diploma or equivalent or post-high school diploma / highest degree earned • Five (5) years hospital/physician billing office and/or healthcare revenue cycle experience • Certified Revenue Cycle Analyst (CRCA) preferred • Proficient computer skills (spreadsheets and excel pivot table skills) • Data entry skills • Mathematical skills • Medical terminology/ICD Coding knowledge • Ability to review/understand all pertinent information such as insurance carrier explanation of benefits, insurance carrier denial letters and electronic remits • Comprehensive understanding of remittance and remark codes • Knowledge of payer edits, rejections, rules, and how to appropriately respond to each

🏖️ Benefits

• Health insurance • Professional development • Flexible work arrangements