Job Details

Analyzes trends specific to denials, root cause, and accounts receivable impact. Resolves account issues or escalates as needed and documents billing activity on the patient accounts according to departmental and regulatory guidelines. This is a remote position. Essential Functions. All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Analyzes and articulates trends specific to denials, root cause, and A/ R impact. Completes and submits claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines and timeliness standards. Contacts payer for inquiries on account status. Escalates account issues as needed and initiates the appeal process. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected complianc...Appeals Specialist, Processing Specialist, Quality Assurance, Specialist, Appeals, High School, Healthcare