Denials & Revenue Integrity Specialist

Coosa Valley Medical Center; Sylacauga (AL); On-site; USD 45,000 - 65,000; Full time

Benefits offered by this job

Competitive Compensation

Health & Dental Insurance Day One

Flexible Schedule Options

Flexible Pay; No More Waiting For Pay

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Job summary

Coosa Valley Medical Center (CVMC) invites you to join our team as a health care billing/denial specialist focused on reviewing denials, authorizations, and DRG-related issues. You will coordinate processes to overturn denials and produce reports to prevent future denials.

The ideal candidate has 2+ years in health care billing, strong Excel skills, and solid knowledge of hospital reimbursement and medical necessity guidelines. We offer competitive compensation and flexible schedule options.

Qualifications

• High school diploma with additional coursework.
• Two years of college knowledge in business or social science.
• Bachelor's degree preferred.
• Strong analytical skills.
• Attention to detail and Microsoft Office experience with advanced Excel (pivot tables/formulas).
• Excel macros knowledge a plus.
• Experience reviewing insurance denials and payments.
• Knowledge of hospital reimbursement, authorization, clinical documentation requirements and medical necessity guidelines.
• Two years' experience in a health care billing office with knowledge of hospital insurance billing/remittance posting.
• DRG calculations, Medicare OPPS, APG knowledge preferred.

Responsibilities

• Coordinates reviews of all insurance denials related to authorizations, DRG downgrades, level of care and medical necessity.
• Coordinates processes to overturn denials and tracks outcomes.
• Produces reporting and helps develops and implement processes to prevent denials.

Skills

Strong analytical skills

Attention to detail

Education

High school diploma with 1–2 years of additional coursework

Two years of college knowledge in business or social science

Bachelor's degree preferred

Tools

Microsoft Excel

Pivot tables

Formulas

Excel macros

Job description

Coosa Valley Medical Center (CVMC) invites you to join our team as a health care billing/denial specialist focused on reviewing denials, authorizations, and DRG-related issues. You will coordinate processes to overturn denials and produce reports to prevent future denials.

The ideal candidate has 2+ years in health care billing, strong Excel skills, and solid knowledge of hospital reimbursement and medical necessity guidelines. We offer competitive compensation and flexible schedule options.