Denials Management Specialist

SHERIDAN MEMORIAL HOSPITAL

At Sheridan Memorial Hospital, we proudly rank in the top 13.6% of U.S. hospitals, recognized by the Centers for Medicare and Medicaid Services. With over 850 dedicated employees and 100+ expert providers across 25 specialties, we are committed to exceptional, patient-centered care. Set in northern Wyoming's stunning Big Horn Mountain foothills, Sheridan offers outdoor adventure and community charm. Our hospital combines cutting-edge technology with a collaborative, innovative culture. Join a team that values your skills, fosters growth, and empowers you to impact lives meaningfully. Apply today and be part of Sheridan Memorial Hospital's mission of excellence!

JOB SUMMARY

Under general direction, the position will review denied claims and appeal when necessary. Knowledgeable with payers including Managed Care, Commercial, Medicare and Medicaid. Prepare appeals related to denied services. Capable of reviewing explanation of benefits (EOB) from payors to determine how the claims were handled. Contact insurance carriers to check on the status of claims, appeals, mailing, registration, and insurance verification

ESSENTIAL JOB FUNCTIONS

Reviews denied claims for categorization, level of appeal, and special requirements for initiating appeals. Utilized denial reports to assess root causes and identify trends. Share findings with stakeholders. Contacting payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection. Make necessary adjustments as required by plan reimbursement. Verifies accurate encounter information by working Edit Failure Working in Cerner, making necessary corrections to insure timely claim submission. Monitors denied claims in Assurance correcting edits as need to insure claim submission and reimbursement. Contacts patients when additional information is required to file an insurance claim or when the insurance company has requested additional information from the member Processes correspondence and Explanation of Benefits in a timely manner. Processes overpayment refunds as required. Timely in making contact with insurance companies on claims that have exceeded the time expectation for payment. Remains current on Worker's Compensation and other third party payors for billing functions. Demonstrates the ability to be flexible, organized and function well in stressful situations. Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage. Treats patients/families with respect; ensures confidentiality of patient records. Maintains a good working relationship within the department and with other departments. Maintains a professional working relationship with insurance companies. Performs other duties as assigned. Ensures documentation meets standards and policies.

POSITION QUALIFCATIONS

Education, Experience & License High school diploma or general equivalency diploma (GED). Two or more years in hospital billing, preferred. Additional Skills Ability to communicate in English, both verbally and in writing. Other languages preferred. Thorough understanding of Medicare, Medicaid, HMO's, PPO's, private insurance companies. Basic computer knowledge, data entry skills.

Location:

Sheridan Memorial Hospital •

Patient Accounts Schedule:

Full Time, Days, M-F, 8:00 am -5:00 pm Denials Management Specialist 3.5 3.5 out of 5 stars 1401 West 5th Street, Sheridan, WY 82801 Full-time Sheridan Memorial Hospital 48 reviews Full-time

SHERIDAN MEMORIAL HOSPITAL

At Sheridan Memorial Hospital, we proudly rank in the top 13.6% of U.S. hospitals, recognized by the Centers for Medicare and Medicaid Services. With over 850 dedicated employees and 100+ expert providers across 25 specialties, we are committed to exceptional, patient-centered care. Set in northern Wyoming's stunning Big Horn Mountain foothills, Sheridan offers outdoor adventure and community charm. Our hospital combines cutting-edge technology with a collaborative, innovative culture. Join a team that values your skills, fosters growth, and empowers you to impact lives meaningfully. Apply today and be part of Sheridan Memorial Hospital's mission of excellence!

JOB SUMMARY

Under general direction, the position will review denied claims and appeal when necessary. Knowledgeable with payers including Managed Care, Commercial, Medicare and Medicaid. Prepare appeals related to denied services. Capable of reviewing explanation of benefits (EOB) from payors to determine how the claims were handled. Contact insurance carriers to check on the status of claims, appeals, mailing, registration, and insurance verification

ESSENTIAL JOB FUNCTIONS

Reviews denied claims for categorization, level of appeal, and special requirements for initiating appeals. Utilized denial reports to assess root causes and identify trends. Share findings with stakeholders. Contacting payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts. Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection. Make necessary adjustments as required by plan reimbursement. Verifies accurate encounter information by working Edit Failure Working in Cerner, making necessary corrections to insure timely claim submission. Monitors denied claims in Assurance correcting edits as need to insure claim submission and reimbursement. Contacts patients when additional information is required to file an insurance claim or when the insurance company has requested additional information from the member Processes correspondence and Explanation of Benefits in a timely manner. Processes overpayment refunds as required. Timely in making contact with insurance companies on claims that have exceeded the time expectation for payment. Remains current on Worker's Compensation and other third party payors for billing functions. Demonstrates the ability to be flexible, organized and function well in stressful situations. Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage. Treats patients/families with respect; ensures confidentiality of patient records. Maintains a good working relationship within the department and with other departments. Maintains a professional working relationship with insurance companies. Performs other duties as assigned. Ensures documentation meets standards and policies.

POSITION QUALIFCATIONS

Education, Experience & License High school diploma or general equivalency diploma (GED). Two or more years in hospital billing, preferred. Additional Skills Ability to communicate in English, both verbally and in writing. Other languages preferred. Thorough understanding of Medicare, Medicaid, HMO's, PPO's, private insurance companies. Basic computer knowledge, data entry skills.

Location:

Sheridan Memorial Hospital •

Patient Accounts Schedule:

Full Time, Days, M-F, 8:00 am -5:00 pm