Medical Denial Specialist - Carolina Nephrology

Overview

IMMEDIATE opening in Greenville for Medical Denial Specialists. We are seeking proactive problem solvers with time management skills that are interested in joining a great team and growing practice. Medical billing experience is required with Epic experience preferred. We will train to ADD TO YOUR current medical billing skills/experience! COME LEARN AND GROW WITH US!

Job Title: Medical Denial Specialist

Job Type: Full time

Location: 203 Mills Avenue Greenville, SC 29605 (this is an in-person position)

Practice Overview: We are a growing medical practice with 9 office locations across the upstate. Our providers care for patients at 21 dialysis locations and multiple hospitals as well.

Job Description

The Denial Specialist is responsible for working denials that are categorized by payer/place of service in various work queues. This includes, but is not limited to, investigating specific denial categories and codes, finding the underlying reason for the denial, correcting the issue and rebilling the claim to ensure that we are properly reimbursed. Overpayment letters from payers that are sent by mail will also be part of this job description. Demonstrate a high level of expertise in the management of denied claims and deploy an analytical approach to resolving denials while recognizing trends and patterns in order to proactively resolve recurring issues. Communicate identified denial patterns to management. Prioritize and process denials while maintaining high quality of work. Serve as an escalation point for unresolved denial issues. Inform team members of payer policy changes. Collaborate on special projects as needed. Assist manager of additional tasks as needed.

Working as a team which includes, but is not limited to, answering incoming phone calls, assisting patients with billing questions, and helping one another when needed.

Responsibilities

Claims

• Appealing denied claims, including researching underlying root cause, collecting required information, adjusting the account as necessary, resubmitting claims to avoid past timely filing guidelines, and all appropriate follow up activities to ensure adjudication of the claim.
• Contacting payers via portals or phone to work the denial efficiently.
• Following up on outstanding claims.
• Insurance verification via portals when appropriate.
• Issuing/requesting payer refunds when appropriate

Patient Interactions

Phone calls or mailing patient letters:

• Answering patient questions/concerns.
• Calling patient when needed for any information needed regarding a claim.
• Collecting patient payments via phone by card.
• Coordination of benefits letters.
• Updating and/or verifying patient insurance information into their registration.

Overpayment Letters - Payers requesting refunds due to various reasons.

• Researching the information on the letter to confirm it is valid.
• Resubmitting the claim to another payer if possible.
• Submitting refund request and finishing the refund process to the payer.

Benefits

• 401(k).
• Dental insurance.
• Health insurance.
• Life insurance.
• Paid time off.
• Vision insurance.

Expected Schedule

• Monday-Friday (8:30-5:00)
• 35-40 hours per week.

Pay

• $16.00-$21.00 per hour

Requirements

Essential Requirements

• 1 year of medical billing experience specifically with appeals, corrected claims, denials, and verification of insurance information.
• Ability to read an explanation of benefits from payers.
• Comfortable communicating denial root causes/resolution to leadership as needed.
• Willing to learn and adapt to updated billing guidelines and/or new changes within the practice.

Preferred Skills

• Epic experience.
• Experience with various payers regarding appeals, corrected claims and denials.
• Familiarity with various insurance portals.
• Minimum of 1 years experience in a medical billing department with strong AR account follow-up, appeals, and coding knowledge is a must.
• Demonstrated knowledge of and experience in Healthcare medical billing, claims processing, follow-up and appeals a must.
• Ability to work independently, flexibly shifting from big picture to detailed tasks, with high productivity, and regularly execute to deadlines.

All offers of employment at Carolina Nephrology, PA are contingent upon clear results of a thorough background check. Background checks will be conducted on all final candidates and on all employees who are promoted, as deemed necessary.

Background checks will include:

• Social Security Verification: validates the applicant's Social Security number, date of birth and former addresses.
• Prior Employment Verification: confirms applicant's employment with the listed companies, including dates of employment, position held and additional information available pertaining to performance rating, reason for departure and eligibility for rehire. This verification will be run on the past two employers or the previous five years, whichever comes first.
• Personal and Professional References: calls will be placed to individuals listed as references by the applicant.
• Educational Verification: confirms the applicant's claimed educational institution, including the years attended and the degree/diploma received.
• Criminal History: includes review of criminal convictions and probation. The following factors will be considered for applicants with a criminal history:
• The nature of the crime and its relationship to the position.
• The time since the conviction.
• The number (if more than one) of convictions.
• Whether hiring, transferring or promoting the applicant would pose an unreasonable risk to the business, its employees or its customers and vendors.

Procedure

Final candidates must complete a background check authorization form and return it to Human Resources.

Human Resources will order the background check upon receipt of the signed release form, and either internal HR staff or an employment screening service will conduct the checks. A designated HR representative will review all results.

The HR representative will notify the hiring manager regarding the results of the check. In instances where negative or incomplete information is obtained, the appropriate management and the director of Human Resources will assess the potential risks and liabilities related to the job's requirements and determine whether the individual should be hired. If a decision not to hire or promote a candidate is made based on the results of a background check, there may be certain additional Fair Credit Reporting Act (FCRA) requirements that will be handled by Human Resources in conjunction with the employment screening service (if applicable).

Background check information will be maintained in a file separate from employees' personnel files for a minimum of five years.

Carolina Nephrology, PA reserves the right to modify this policy at any time without notice.