Denials and Appeals Specialist, FT, Days, – Remote Position Available In Richland, South Carolina
Tallo's Job Summary: The Denials and Appeals Specialist position in Columbia, South Carolina, is a full-time remote job focused on analyzing trends, submitting claims, contacting payers, and ensuring compliance with regulations. The role requires a high school diploma, 2 years of billing experience, and the ability to operate in various specialized roles within the department. This non-management position reports to a supervisor, manager, director, or executive at Prisma Health. Join us in transforming healthcare for our communities.
Job Description
Denials and Appeals Specialist, FT, Days, – Remote Columbia, South Carolina Job Id
R1101610
Category
Administrative and Clerical Full time Previous job Inspire health. Serve with compassion. Be the difference. Job Summary
ACCOUNTABILITIES
Analyzes and articulates trends specific to denials, root cause, and A/R impact 25%
Completes and submits claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines and timeliness standards 10%
Contacts payer and makes hard inquiries on account status. Escalates problem account and initiates the appeal process. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders. Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis 25%
Ensures all work is compliant with privacy, HIPAA, and regulatory requirements 10%
Participates in general or special assignments and attends all required training 10%
Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance 10%
Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross trained and proficient operate in any of these roles if the need arises. 10%
SUPERVISORY/MANAGEMENT RESPONSIBILITIES
This is a non-management job that will report to a supervisor, manager, director or executive.
MINIMUM EDUCATION
High School diploma or equivalent preferred
MINIMUM EXPERIENCE 2
years- Billing, bookkeeping, accounting
REQUIRED CERTIFICATIONS, REGISTRATIONS, LICENSES N/A KNOWLEDGE, SKILLS OR ABILITIES
Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross trained and proficient operate in any of these roles if the need arises. 10% Work Shift Day (United States of America) Location 1200 Colonial Life Blvd Facility 7001 Corporate Department 70019227 PBO Other Specialties A/R Team Share your talent with us!
Our vision is simple:
to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
