Denials & Appeals Specialist - Central Business Office (CBO) Management

Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Denials & Appeals Specialist is responsible for appealing denied claims. As a Denials & Appeals Specialist, you will effectively interact with multiple disciplines including Clinical Service Areas, Hospital Information Management, Charge Description Master, Corporate Compliance, private insurance and government agencies. Must demonstrate self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to hospital services.

As a Denials & Appeals Specialist, you will:

• Maintain working knowledge of payer rules, regulations and contracts so that appeals are filed timely and accurately to recover payment
   
• Review medical documentation in order to prepare appeals and related filings to support medical necessity of services
   
• Collaborate with  clinical service areas as needed to develop appeals and/or help reduce denials due to lack of documentation
   
• Manage appeals on a daily basis that are housed in multiple denial work queues that are subject to mix levels of priorities / deadlines.
   
• Comprehensive decision logic and analysis skills 
   
• Maintain confidentiality and comply with HIPAA and fraud and abuse policies and procedures
   
• Review  claim denials from  Third Party Payers and file appeals to recover payment for denied services for ECU Health Hospitals and Surgicenter

Minimum Requirements

• Associate degree (or higher) in Business, Healthcare Administration, Health Information Management or related. A clinical degree (LPN, ADN or BSN) also meets the requirement.
   
• 2+ years experience with clinical denials and appeals for hospital billing is required.

Preferred:

• 3 to 5 years of experience in Revenue Cycle Operations. 
   
• Coding Certification (ex. CCSP, RHIT)
   
• Excellent grammar, written and oral communication skills. Working knowledge of Microsoft Excel and Word & basic typing ability.

Other Information

• 40 hours per week
• Remote (#LI-Remote)
• Monday - Friday (8 am - 5 pm)
• Great Benefits

#LI-SB1

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.