Denials Specialist - Richmond, United States - Reid Health

Description

This position is responsible for the optimal payment of claims from all payers. Focus will include follow-up/appeal of denied claims.

Our values of Excellence, Empathy, Integrity and Accountability are essential to exceed our customers' expectations. At Reid, we look for individuals who believe in our core values and demonstrate a genuine desire to make a positive impact to those we serve. We take pride in employing people who show up every day with a commitment to these values along with our mission and vision. We are one team working toward a common goal of providing outstanding customer care and service to our communities. If you have a calling to serve and are looking for meaningful and purposeful work, Reid Health is the place for you.

To lead our communities to well-being, one person at a time. It is not just what we do – it is who we are.

• Consistent follow-up of unpaid/denied claims utilizing Reid Health financial system (Epic Resolute Hospital/Professional Billing System) and work queues
• Filing appeals when appropriate to obtain maximum reimbursement
• Review and analyze insurance claims with accounts receivable balances
• Accesses denied claims and queries claim status, effectively research the claim and resubmit or appeal as necessary
• Identify underpayments and take necessary steps needed to receive the full insurance allowable as per the contract
• Verified insurance coverage by investigation or interview.
• Responsible for modifications to the patient's financial information which may include adding or deleting charges, providing special research or overall review or search for reimbursement corrections.
• Follows compliance with all laws, regulations, and guidelines of federal and state programs with an emphasis on prevention of fraud, waste, and abuse.
• Position includes other duties and projects as assigned to support goals and outcomes consistent with department expectations.
• Attends meetings as requested.

Education Required:

• High school diploma or GED.

Experience Required:

• 1-3 years' experience in the hospital billing, medical, auditing, and follow up areas. Experience in a physician's office will also be considered.
• Computer experience, including but not limited to word processing and spreadsheet applications (i.e. Microsoft Excel)
• Ability to perform mathematical computations
• Possess effective oral and written communications skills, time management skills, and the ability to multi-task
• Skilled in defining problems, collecting data and interpreting billing information

Unexpected Perks - Daycare, Doordash, SmartDollar, Daily Pay, therapy dogs, massages, Forbes rated Best Places to Work 2022

Not quite what you are looking for? Submit your information for general consideration. One of our employment specialists will be in touch with next steps.

EEO Statement:

No Search Firms:

Reid Health does not accept unsolicited assistance from search firms for employment opportunities. Please do not call or email. All resumes submitted by search firms to any employee or other representative at Reid Health via email, the internet or in any form and/or method without a vaild written search agreement in place and approved by HR will result in no fee being paid in the event the candidate is hired by Reid Health.

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