Insurance Denial Optimization Specialist – Flexible Schedule

Cvhealth; Sylacauga (AL); On-site; USD 42,000 - 60,000; Full time

Benefits offered by this job

Health & Dental Insurance Day One

Competitive Compensation

Flexible Schedule Options

Flexible Pay

Job summary

Coosa Valley Medical Center (CVMC) is a progressive health care organization that emphasizes high-quality patient care. This role focuses on reviewing and overturning insurance denials, tracking outcomes, and producing reports to prevent future denials.

Ideal candidates have strong Excel skills, experience in hospital billing, and knowledge of DRG/Medicare guidelines. This is a full-time onsite position in Sylacauga, AL with competitive compensation.

Qualifications

• High school plus one to two years' additional course work.
• Knowledge of field of business or social science acquired through two years of college.
• Bachelor\'s degree preferred.
• Strong analytical skills.
• Attention to detail and must have Microsoft office experience with advanced Excel skills including use of pivot tables and formulas.
• Excel macro knowledge a plus.
• Experience reviewing insurance denials and payments.
• Strong 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 and/or remittance posting required.
• 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

Analytical skills

Attention to detail

Excel macros

Hospital reimbursement knowledge

Authorization knowledge

Clinical documentation requirements

Medical necessity guidelines

Remittance posting experience

Education

High school plus 1–2 years college

Two years of college in business or social science

Bachelor's degree preferred

Tools

Microsoft Excel

Pivot tables

Formulas

Job description

Coosa Valley Medical Center (CVMC) is a progressive health care organization that emphasizes high-quality patient care. This role focuses on reviewing and overturning insurance denials, tracking outcomes, and producing reports to prevent future denials.

Ideal candidates have strong Excel skills, experience in hospital billing, and knowledge of DRG/Medicare guidelines. This is a full-time onsite position in Sylacauga, AL with competitive compensation.