New

Denials and Appeals Specialist, FT, Days, - Remote

Prisma Health
United States, South Carolina, Columbia
Jul 20, 2025
Inspire health. Serve with compassion. Be the difference. Job Summary Analyzes trends specific to denials, root cause, and accounts receivable impact. Resolves account issues or escalates as needed and documents billing activity on the patient accounts according to departmental and regulatory guidelines. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Analyzes and articulates trends specific to denials, root cause, and A/R impact Completes and submits claims via electronic or paper claim submission according to governmental regulations, agency policies, Prisma Health guidelines and timeliness standards Contacts payer for inquiries on account status. Escalates account issues as needed and initiates the appeal process. Documents billing activity on the patient accounts according to departmental guidelines; ensures compliance with all applicable billing regulations and reports any suspected compliance issues to departmental leaders. Properly documents accounts clearly with indicators and activities so that tracking and trending can be prepared for further analysis Adheres to policies and procedures as required by Prisma Health and follows all compliant regulatory payer guidance. Ensures all work is compliant with privacy, HIPAA, and regulatory requirements Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Should be cross trained and proficient operate in any of these roles if the need arises. Performs other duties as required. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Education - High School diploma or equivalent OR post-high school diploma/highest degree earned Experience - Two (2) years billing, bookkeeping, accounting experience In Lieu Of NA Required Certifications, Registrations, Licenses NA Knowledge, Skills, and Abilities Knowledgeable of the job functions required for a Credit Processing Specialist, Payment Research Specialist, and a Quality Assurance Specialist. Work Shift Day (United States of America) Location 1200 Colonial Life Blvd Facility 7001 Corporate Department 70019227 PBO Other Specialties A/R Team Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.