Denials Specialist

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 Specialist will be responsible for researching, analyzing, resolving and trending rejections and/or denials specific to the revenue cycle. This includes, but is not limited to, analyzing specific denial categories and codes, researching the underlying reason for the denial, rectifying the issue in the patient management system and ensuring that the claim is adjudicated.

The Denials Specialist should be able to identify potential process improvement opportunities and offer recommendations for correcting these issues. The Denials Specialist will be responsible for understanding how all of the various components of the revenue cycle can potentially cause a denial and possible solutions that may result from the interaction of these components. The Denials Specialist will have to be a problem solver and possess the ability to use the resources available to rectify a denial.

The Denials Specialist should be able to analyze Managed Care contracts and reconcile payments received. Contact insurance companies to have adjustments processed and/or file appeals if payments are not in accordance with the contract. The Denials Specialist will have direct interaction with all Managers and/or Department Heads regarding administrative issues related to rejections and/or denials.

Minimum Requirements

High school diploma, equivalent or higher

5 or more years of experience in billing, A/R follow up, denials management & appeal writing


Skill Set Requirement:

Proficient in payment review systems, hospital information systems and coding methodologies.

Strong quantitative, analytical and organizational skills.

Advanced understanding of an Explanation of Benefits (EOB)

Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards

Understand CMS Memos and Transmittals.

Understand medical records, professional claims, and the Charge master.

Utilize and understand computer technology.

Understand all ancillary charges and multi-specialty departmental functions.

Communicate orally and in written form.

Understand insurance terms and payment methodologies.

Work with physicians, administrative staff, and department managers effectively.

Identify accurate Revenue code(s), CPT codes, and HCPCS codes for services/items.

Identify clerical error, mistakes in interpretation, imprecise records, and inaccurate service code assignment.

Perform reviews for appropriateness of coding and charging, including business office activities, systems function, and charging methodologies.


Additional Skill Set Requirement:

Strong Understanding of the inter-relationships of the Revenue Cycle Departments

Strong Understanding of Patient Financial Information System and Billing System

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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 applicant’s 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.