Denials & Appeals Specialist - Central Business Office (CBO) Management

ECU Health; Greenville (NC); Remote; USD 50,000 - 70,000; Full time

Job summary

Join ECU Health as a Denials & Appeals Specialist, where you'll handle the appeals process for denied claims in a vibrant healthcare setting. With a focus on effective communication and regulatory knowledge, you'll work closely with clinical staff to minimize denials and ensure compliance. This full-time position offers a supportive work environment with opportunities for growth.

Benefits

Great Benefits

Qualifications

• Associate degree or higher in relevant fields required.
• Minimum 2 years experience handling clinical denials and appeals.
• Competence in effective communication and confidentiality compliance.

Responsibilities

• Manage and review denied claims to file accurate appeals.
• Collaborate with clinical service areas for documentation support.
• Maintain knowledge of payer regulations and confidentiality policies.

Skills

Effective communication

Decision logic and analysis skills

Working knowledge of denials

Education

Associate degree in Business or Healthcare Administration

Clinical degree (LPN, ADN or BSN)

Tools

Microsoft Excel

Microsoft Word

Job description

Denials & Appeals Specialist - Central Business Office (CBO) Management

Join to apply for the Denials & Appeals Specialist - Central Business Office (CBO) Management role at ECU Health

Continue with Google Continue with Google

Denials & Appeals Specialist - Central Business Office (CBO) Management

1 day ago Be among the first 25 applicants

Join to apply for the Denials & Appeals Specialist - Central Business Office (CBO) Management role at ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Denials & Appeals Specialist is responsible for appealing denied claims. As a Denials & Appeals Specialist, you will effectively interact with multiple disciplines including Clinical Service Areas, Hospital Information Management, Charge Description Master, Corporate Compliance, private insurance and government agencies. Must demonstrate self-direction, professionalism, effective communication skills, a working knowledge of denials, and an expertise in understanding private and governmental regulations as it applies to hospital services.

As a Denials & Appeals Specialist, You Will

• Maintain working knowledge of payer rules, regulations and contracts so that appeals are filed timely and accurately to recover payment
• Review medical documentation in order to prepare appeals and related filings to support medical necessity of services
• Collaborate with clinical service areas as needed to develop appeals and/or help reduce denials due to lack of documentation
• Manage appeals on a daily basis that are housed in multiple denial work queues that are subject to mix levels of priorities / deadlines.
• Comprehensive decision logic and analysis skills
• Maintain confidentiality and comply with HIPAA and fraud and abuse policies and procedures
• Review claim denials from Third Party Payers and file appeals to recover payment for denied services for ECU Health Hospitals and Surgicenter
  
  

Minimum Requirements

• Associate degree (or higher) in Business, Healthcare Administration, Health Information Management or related. A clinical degree (LPN, ADN or BSN) also meets the requirement.
• 2+ years experience with clinical denials and appeals for hospital billing is required.
  
  

Preferred

• 3 to 5 years of experience in Revenue Cycle Operations.
• Coding Certification (ex. CCSP, RHIT)
• Excellent grammar, written and oral communication skills. Working knowledge of Microsoft Excel and Word & basic typing ability.
  
  

Other Information

• 40 hours per week
• Remote ()
• Monday - Friday (8 am - 5 pm)
• Great Benefits
  
  

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicants qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at ECU Health by 2x

Get notified about new Denials & Appeals Specialist - Central Business Office (CBO) Management jobs in Greenville, NC.

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.