Prisma Health ยท 1 week ago
Patient Financial Specialist Denials & Appeals Specialist, FT, Days
Greenville, SC
Full-time
Onsite
Senior Level
5+ years expPrisma Health is committed to transforming healthcare for the benefit of the communities they serve. The Patient Financial Specialist Denials & Appeals Specialist is responsible for pursuing denied accounts, ensuring timely follow-up, and managing the appeals process to achieve optimal payment for services rendered.
Health CareHospitalMedical
Responsibilities
Responsible for resolution of denied claims and/or initiate/manage/follow-up on reconsiderations/appeals in a timely manner
Monitors denial work queues and reports in accordance with assignments from direct supervisor and communicates all denial trends, denial increases, etc. to direct supervisor/PFS management in order to positively affect the volume of denials
Participates in departmental huddles and team meetings involving discussion of A/R processes and denial trends
Maintains required levels of productivity and quality while managing tasks in work queues to ensure timeliness of follow-up and appeals
Organizes denial/rejection related tasks to identify patterns and/or work most efficiently (e.g., by current procedural terminology, diagnosis, payer, etc.)
Identifies and monitors negative patterns in denials/rejections. Escalates accordingly to PFS management and the impacted department(s) to avoid negative impact on reimbursement, unsuccessful appeals, and/or increased write-offs
Uses identified and known resources to accomplish follow-up on tasks. Identifies other means and resources to complete tasks, as applicable and appropriate. As needed, participates in A/R clean-up projects or other projects identified by direct supervisor or PFS management
Comply with all government regulatory mandated requirements for billing and collections
Works with other departments to resolve A/R and payer issues. Communicates with other departments on issues that may have negative impact on their cash flow, timely claim reconsideration/filing, failed appeals, and/or increased denials and write-offs
Enters and documents appropriate accounts for adjustments utilizing the appropriate adjustment codes
Identifies and researches all payer issues to the Payer SharePoint in a timely manner and continues to follow-up on said SharePoint information on a weekly basis
Performs other duties as assigned
Qualification
Required
High School diploma or equivalent or post-high school diploma / highest degree earned
Five (5) years hospital/physician billing office and/or healthcare revenue cycle experience
Certified Revenue Cycle Analyst (CRCA) preferred
Proficient computer skills (spreadsheets and excel pivot table skills)
Data entry skills
Mathematical skills
Medical terminology/ICD Coding
Preferred
Bachelor's degree and two years of related work experience
Knowledge of current trends and developments in the healthcare industry and specifically as it relates to denials/appeals through appropriate literature and professional development activities
Self-motivation and ability to demonstrate initiative, excellent time management skills, and organizational capabilities and must be able to multi-task in a fast-paced environment and appropriately handle overlapping commitments and deadlines
Ability to review/understand all pertinent information such as insurance carrier explanation of benefits, insurance carrier denial letters and electronic remits to ensure denials are worked in a timely manner and reconsideration/appeals for the denial claims are submitted appropriately
Comprehensive understanding of remittance and remark codes
Knowledge of payer edits, rejections, rules, and how to appropriately respond to each
Working knowledge of UB-04 claim forms
Company
Prisma Health
Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually.
10001+ employees
H1B Sponsorship
Prisma Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (1)
2022 (1)
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
CDA Foundation
2024-07-30Grant
Leadership Team
Mark O'Halla
President & CEO
B
Barrett Ludley
Facility Chief Financial Officer
Recent News
2026-01-16
Precedence Research
2025-09-09
Company data provided by crunchbase