Medical Denials Specialist: Claims Resolution Expert

Carolina-Nephrology,-P; Greenville (SC); Vor Ort; USD 51.577.000 - 60.174.000; Vollzeit

Benefits dieser Stelle

401(k)

Paid Holidays

PTO

Dental/Health/Vision Insurance

Zusammenfassung

Carolina Nephrology, PA is seeking an experienced Medical Denials Specialist for our Greenville, SC location. This full-time role requires at least three years of direct medical denial management in a healthcare setting, with in-office duties and routine patient interactions.

You will manage denied professional claims, monitor deadlines, and support billing operations across multiple locations. On-site schedule is Monday–Friday, 8:30am–5:00pm, with competitive pay and benefits.

Qualifikationen

• Minimum of three years of direct medical denial management experience.
• Knowledge of health insurance eligibility, COB, payer order, and impact on claim processing.
• Ability to read and interpret payer EOBs/ERAs and use denial information for action.
• Ability to communicate denial trends and present resolutions to leadership.
• Strong organizational, time-management, critical-thinking, and problem-solving skills.
• Ability to manage multiple work queues and prioritize accounts by status and deadlines.
• Willingness to learn and adapt to changing payer requirements and practice processes.
• High school diploma or equivalency.

Aufgaben

• Research and resolve denied claims by identifying root causes and submitting appeals or corrected claims.
• Monitor timely filing and appeal deadlines.
• Follow up on outstanding claims and appeals.
• Research claim status and denial issues through payer portals or direct payer communication.
• Investigate insurance-related denials including eligibility, COB, and coordination of benefits.
• Review EOB/ERA information to identify denial reasons and determine next steps.
• Document denial research, payer communications, and follow-up in patient accounts.
• Assist with answering calls and patient billing questions when needed.

Kenntnisse

Denial management

Research and analysis

Attention to detail

Time management

Prioritization

Ausbildung

High school diploma or equivalency

Tools

Epic experience

Jobbeschreibung

Carolina Nephrology, PA is seeking an experienced Medical Denials Specialist for our Greenville, SC location. This full-time role requires at least three years of direct medical denial management in a healthcare setting, with in-office duties and routine patient interactions.

You will manage denied professional claims, monitor deadlines, and support billing operations across multiple locations. On-site schedule is Monday–Friday, 8:30am–5:00pm, with competitive pay and benefits.