Senior Appeal and Denial Specialist Jobs in USA Full Time

Embark on a rewarding career with Sanford Health as a Senior Appeal and Denial Specialist in the USA. Your expertise will be pivotal in managing complex claim issues and driving optimal financial outcomes. Join a team dedicated to excellence and healthcare innovation by applying for these Senior Appeal and Denial Specialist Jobs in USA.

Senior Appeal and Denial Specialist Jobs in USA Key Details

• Name of Company: Sanford Health
• Location: Sioux Falls, South Dakota, United States
• Title: Appeal and Denial Specialist
• Working Schedule: Full-Time
• Pay Range: 2600$-3400$

Job Overview

As a Senior Appeal and Denial Specialist at Sanford Health in the USA, you’ll be at the forefront of resolving intricate billing issues and claim disputes. Your role will involve analyzing denial trends, implementing strategic solutions, and improving revenue cycle efficiency. Collaboration with various healthcare professionals to ensure compliance and accuracy is essential. This position requires strong analytical skills and a keen eye for detail. You’ll contribute to Sanford Health’s mission by ensuring that billing processes uphold the highest standards of financial integrity.

Key Prerequisites

Here are the essential qualifications and skills needed for the Senior Appeal and Denial Specialist role:

• Educational Background: A bachelor’s degree in finance, healthcare administration, or a related field is required. Advanced certifications in medical coding or billing are preferred to ensure a thorough understanding of the healthcare billing process.
• Experience: A minimum of 3-5 years of experience in healthcare billing, claims processing, or denial management is essential. Prior experience in a senior or supervisory role will be an added advantage.
• Technical Proficiency: Proficiency with medical billing software and electronic health records (EHR) systems is crucial. Familiarity with coding principles (ICD-10, CPT) and payer-specific guidelines is necessary for accurate claim resolution.
• Analytical Skills: Strong analytical capabilities to assess denial trends and develop effective strategies to address them. The ability to interpret complex data and provide actionable insights is critical to success in this role.
• Communication Skills: Excellent verbal and written communication skills to articulate findings and solutions clearly. Must be able to interact professionally with various stakeholders, including healthcare providers and insurance representatives.
• Detail-oriented: A keen eye for detail to ensure precision in all billing and appeal activities. The ability to identify discrepancies and implement effective corrective measures is key.
• Problem-Solving Abilities: Proactive problem-solving skills to address and resolve claim issues effectively. The capacity to think creatively and implement innovative strategies to reduce denials is essential.
• Regulatory Knowledge: In-depth knowledge of federal and state regulations, including HIPAA and Medicare/Medicaid guidelines, to ensure compliance and uphold ethical standards in billing practices.

Key Duties

The Senior Appeal and Denial Specialist will manage and execute strategies to optimize claim approvals and reduce denials.

• Analyze and Resolve Denials: Thoroughly investigate and analyze denied claims to identify the root cause of denials. Develop and implement strategies to effectively resolve these issues, ensuring accurate and timely reimbursement.
• Identify Denial Trends: Monitor and track denial patterns to identify systemic issues within the billing process. Work collaboratively with the billing, coding, and clinical teams to implement improvements that address these trends.
• Appeal Preparation and Submission: Prepare and submit comprehensive appeal packets to insurance companies, substantiating claims with necessary documentation and evidence to support payment.
• Maintain Compliance: Ensure that all appeal and denial management processes are in strict compliance with federal and state regulatory guidelines, including HIPAA and other payer-specific requirements.
• Collaborate with Departments: Engage with various departments, including clinical, billing, and coding teams, to ensure that claims meet documentation and coding standards. Collaborate to enhance process efficiency and reduce denial rates.
• Audit Claims: Conduct regular audits of submitted claims to assess compliance with billing policies and regulations. Identify areas of improvement and recommend policy or practice changes where necessary.
• Provide Training and Education: Educate team members on denial prevention strategies and changes in billing regulations. Develop training materials and conduct workshops to enhance understanding of effective billing and appeal practices.
• Generate Reports and Insights: Compile and analyze data to generate detailed reports on denial trends, resolution outcomes, and financial performance. Present findings to management and stakeholders, providing insights and recommendations for process enhancement.

Application Process

To apply for the Senior Appeal and Denial Specialist position at Sanford Health, visit our careers page and search for the job title. Complete the online application form.