Revenue Cycle Denials & Eligibility Lead

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

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.