Denials and Eligibility Specialist

St. Joseph's/Candler; Savannah (GA); On-site; USD 52,000 - 76,000; Full time

Job summary

St. Joseph's/Candler in Savannah, GA seeks a Revenue Cycle Denials and Eligibility Specialist to manage daily QA, eligibility checks, and frontend rejections across Government, Commercial, and Managed Care payers.

The role collaborates with physicians and departments to ensure timely and accurate submissions. You will work with management, precertification, and insurance verification to identify denial trends, implement corrective actions, and provide ongoing education based on audit results.

Qualifications

• Directly resolves eligibility denials in billing system and from payer remits within 1 business day.
• Directly resolves all RQA errors within 1 business day.
• Completes monthly Root Cause Analysis on denials and eligibility to determine trends and inform leadership.
• Reviews monthly denials with leadership to identify improvement opportunities and reduction of denials.

Responsibilities

• Escalates eligibility and payer denial trends or underpayments to leadership for quick resolution.
• Educates staff based on identified trends and audit results.

Skills

Team leadership

Attention to detail

Communication

Job description

• Revenue Cycle Denials and Eligibility Specialist will be responsible for daily QA, eligibility, frontend rejections, denial auditing, and immediate correction of all registered accounts to ensure accurate billing and reimbursement. The scope of work will encompass all Government, Commercial, and Managed Care payers, and include all service lines and all denial types. Position will be a liaison with other departments, physicians and other clinicians within and outside the organization in order to facilitate timely and accurate submission. This position will work closely with management, precertification, insurance verification, and operations to ensure trends are identified and corrected to reduce denials. Revenue Cycle Denials and Eligibility Specialist will also be involved with education and training based on identified trends and audit results.
• Education
• None Required
• Experience
• 2-3 years hospital revenue cycle experience
• 1-2 Years insurance experience
• Previous Team Lead or Supervisor Experience - Preferred
• License & Certification
• None Required
• Core Job Functions
• Directly works to resolve all eligibility denials in billing system and from payer remits within 1 business day. Directly resolves all RQA errors within 1 business day.
• Completes monthly Root Cause Analysis on denials and eligibility to determine trends and using the results to keep leadership informed and provide continuing education and improvement.
• Reviews monthly denials with leadership teams of the physician's office, ancillary departments and revenue cycle. Identifies improvement opportunities, educational needs and reduction of denials opportunities.
• Escalates eligibility and payer denial trends or underpayments to appropriate internal leadership for quick resolution.