Denials Specialist | Billing-Government

Wake Forest Baptist Health
Job Title: Denials Specialist
Job ID: 5423
Full/Part Time: Full-Time
Regular/Temporary: Regular
Job Category: Advanced Practical-Clinical
Winston-Salem, NCAdvanced Practical-Clinical, Medical, Healthcare12/31/2013Denials SpecialistFull-time Regular, 40 hours/week JOB SUMMARY: Responsible for reviewing and researching denied insurance claims. Works with insurance companies, patients, physicians and medical center departments based on denials to maximize payments to the medical center. Provides...

Job Description


Denials Specialist

Full-time Regular, 40 hours/week

JOB SUMMARY:
Responsible for reviewing and researching denied insurance claims. Works with insurance companies, patients, physicians and medical center departments based on denials to maximize payments to the medical center. Provides information to customers and their insurance carrier to insure maximum reimbursement and customer satisfaction. Must possess a thorough knowledge of medical center procedures and current state and federal laws.

EDUCATION/EXPERIENCE:
High school diploma or equivalent plus four years business related experience in the medical field

REPORTS TO:
Manager, Verification and Quality Services

LICENSURE, CERTIFICATION, and/or REGISTRATION:
Certification in Medical Business Office is a Plus

ESSENTIAL FUNCTIONS:
1. Reviews information in HealthQuest and other online systems for accurate insurance verification information.
2. Reviews procedures in order to identify opportunities for improvement.
3. Follows through with the denial process to completion.
4. Maintains open lines of communication between all parties involved.
5. Maintains professional and technical knowledge by utilizing all available applicable resources.
6. Demonstrates the ability to work independently.
7. Assists with special projects and training efforts.

SKILLS&QUALIFICATIONS:
Thorough knowledge of insurance billing and collection procedures and associated state and federal laws
User experience with personal computer and mainframe terminals
Good communication skills, including verbal, nonverbal and listening skills
Fundamental math skills and abilities
Self-motivation and organizational skills
Strong analytical and problem-solving skills
Knowledge of medical terminology
Working knowledge of the Trial Balance, Accounts Receivable, Liabilities and assets for Financial Statements preferred
Experience in use of applicable software programs and electronic mail
Bilingual a plus

WORK ENVIRONMENT:
Subject to highly stressful conditions.
Teamwork required.
Typical business office conditions ? clean and well lit, comfortable climate

To apply for this position, please click on the "Apply Now" button on this page. You must complete the application process and then submit your application by clicking on the "Submit" button located at the bottom of the page titled "Submit Online Application". You will receive the following message once you hit the submit button: "You have successfully submitted your job application".

Computers are available for applying within the lobby of the Human Resources Department located at 1920 West First Street, (on the corner of Miller and First Street) Winston-Salem, North Carolina 27104. You may also call our office for assistance at (336) 716-0175. Office hours are Monday-Friday, 8:00am-5:00pm.

If you are an individual with a disability and need reasonable accommodation to participate in the application process, please contact our Supervisor of Office Services by phone (336) 716-3367 or email at accommodationrequest@wakehealth.edu.

It is the policy of Wake Forest Baptist Medical Center to administer all educational and employment activities without discrimination because of race, sex, age, religion, national origin, disability, sexual orientation or veteran status (except where sex is a bona fide occupational qualification or a statutory requirement) in accordance with all local, state, national laws, executive orders, regulations, and guidelines.



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