Denial Management Specialist (REMOTE)

(Full Time, Remote)
The Denials Management Specialist is responsible for working assigned denials and appeals claims by communicating with all necessary departments to identify and resolve denials trends and issues.

As a Call Center Representative at CHS Shared Service Center - Nashville, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including health insurance, flexible scheduling, 401k and other elective benefit programs.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• The Specialist will monitor assigned pools and duties in Artiva, HMS, Hyland, BARRT and other host systems and applications with currency to follow up dates.
• File appeals as needed to resolve payer denials and work with payers and monitor appeals in process. Properly track and document all denial and appeal activity.
• Maintain working knowledge of all payer guidelines and requirements as they relate to denials and appeals.
• Maintain BARRT requests (Outbound/Inbound) timely. Maintain all logs, account notes and system records as assigned.
• Review and work RAC/Government Audit accounts as needed. Monitor AB rebills that are needed on RAC accounts and post recovery or denial adjustments as needed
• Help identify issues from denials and appeals that might be avoided on future claims. Review and analyze all denial trends and issues as assigned.

QUALIFICATIONS

REQUIRED EDUCATION  

• Diploma or Equivalent education

REQUIRED EXPERIENCE

• Minimum 1 year experience in healthcare setting with experience in medical terminology.
• Experience in revenue cycle processes in a hospital or physician office.

KNOWLEDGE, SKILLS, AND ABILITIES

• • Intermediate knowledge of Microsoft Office tools and/or Google platforms

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.