Denials and Appeals Specialist

If you care about the opportunity to grow, to make a difference, to build a future and a life, then we just might have the career for you. Care to talk?

Bayhealth Medical Center is Central and Southern Delaware’s healthcare leader with hospitals in Dover and Milford, as well as stand-alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!

Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:

• Generous Paid Time Off and Paid Holidays
• Matching 401(k)/403(b) Plans
• Excellent Health, Dental, and Vision
• Disability and Life Insurance options
• On Site Child Care
• Educational Reimbursement
• Health Care and Dependent Care Flex Spending Accounts
• Plus, an array of Voluntary Benefits to include Critical Care Coverage and more!

Location: Kent Campus Hospital

Status: Full Time 80 Hours

Shift: Variable

General Summary:

The specialist is responsible for reviewing and processing of charges as well as researching and appealing denied claims. The Specialist must effectively interact with multiple disciplines including Patient Access, Hospital Information Management, Contract management, patient Financial Services, physicians, private insurance and government agencies. The Specialist demonstrates self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to physician office services.

Responsibilities:

• Review and process charges to help ensure clean claims and invoices. Contact providers and clinical staff with any questions to process charges correctly.
• Work follow-up work queues to process denials on a daily basis, resubmitting claims and writing appeals as appropriate based on the denial. Completion of necessary payer reconsideration forms. Recording of identified issues into payer issue logs/spreadsheets.
• Timely follow-up/communication with payer on appeals submitted until a final resolution has been reached.
• Monitor and track submitted appeals; monitors reduction of denial volume and reduction of backlog of non-reconciled denials.
• Based on the nature of the denials, determine potential root causes, flag/track repetitive issues and communicate progress to management on a monthly basis. Identification of departmental process/procedure improvements and/or education as needed to address prospective denials avoidance.
• Strong working knowledge of payer contracts and Federal program claim submission guidelines.
• Perform registration and scheduling duties to be able to participate in process improvement on a routine basis.
• Perform cash posting and reconciliation for Occupational Health.
• All other duties as assigned within the scope and range of job responsibilities

Required Education, Credential(s) and Experience:

• Education: Associate Degree or High School Diploma or GED; or four years of patient accounting experience.
• Credential(s): None Required
• Experience: Required: Four years hospital/physician office patient Accounting including billing, collections, insurance authorization and A/R. Preferred: Five years hospital/physician office billing or collections experience. Prior written clinical appeal experience.

Preferred Education, Credential(s) and Experience:

• Education: Bachelor Degree in Business or Finance
• Credential(s): Certified Patients Account Manager
• Experience: See above

To view a full list of all open positions at Bayhealth, please visit: https://apply.bayhealth.org/join/