Clinical Appeals Analyst Jobs (NOW HIRING)

At Singing River Health System, caring isn't just part of the job - it's in our DNA. Whether we're saving lives, supporting behind the scenes, or showing up for our community, we bring the energy, heart, and hustle every single day.

With pride, passion, and commitment, we will improve health and save lives in our community every day.

Shift:

Location:

Position Overview:
The Denials and Appeals Analyst assists in the recovery of Health System revenue by managing the life cycle of denied claims. They work collaboratively with departmental peers throughout the System to achieve departmental and system-wide quality, satisfaction, and financial goals. The Denials and Appeals Analyst coordinates the appeals process for denials deemed appropriate by the Patient Financial Services Director and the Denials Manager. They assure prompt action is taken on assigned denials by coordinating with clinical staff to create written and/or verbal clinical appeals with payers. The Analyst works closely with third party payors, Managed Care representatives, insurance billing staff, case management, and other service departments to resolve denied claims. They are a liaison which communicates claim denials related status and updated information to Organizational Leaders. Expectation is for all performed duties to be in accordance with Singing River Health System procedures and policies, accreditation organization, and governing guidance and publications for health care employees.

DISCLAIMER: This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this intends to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks performed as assigned.

Education:
High School Diploma or equivalent required; Associate's degree preferred.

License:
N/A

Certifications:
Epic certification in Resolute Hospital Billing and/or Certified Coding Specialist preferred
Must have de-escalation training completed by the end of position orientation (90 days); must have appropriate level of de-escalation training.

Experience:
A minimum of three (3) years' patient accounting and insurance experience required. Experience in a hospital and/or physician office preferred.

Reports to:
Denials Manager

Supervises:
None

Physical Demands:
Work is moderately active: involves sitting with frequent requirements to move about the office, move about the facility, and to travel to another facility within the SRHS service area. Work involves exerting a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Work involves using many physical motions in performing daily work activities; subject to exposure of body fluids, sputum and tissues, which may carry the hazard of infectious disease. Work involves using repetitive motions: substantial movements of the wrists, hands, and or fingers while operating standard office equipment such as computer keyboard.

Work involves being able to perceive the nature of sound at normal speaking levels with or without correction; the ability to make fine discriminations in sound. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision.

Must be able to be active for extended periods of time without experiencing undue fatigue. Must be able to work schedules assigned with the understanding that changes may be instituted according to the needs of the hospital for off days, shifts or weekends.

Mental Demands:
Must demonstrate keen mental faculties/assessment and decision making abilities. Must demonstrate superior communication/speaking/enunciation skills to receive and give information in person and by telephone. Must demonstrate strong written and verbal communication skills. Must possess emotional stability conducive to dealing with high stress levels. Must demonstrate ability to work under pressure and meet deadlines.
Attention to detail and the ability to multi-task in complex situations is required. Must have the ability to maintain collaborative and respectable working relationships throughout SRHS and other organizations.

Special Demands:
Must possess superior customer service skills and professional etiquette. Must possess proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook and Word.

Job may require traveling throughout the SRHS service area - with the employee providing their own transportation. Travel for education purposes may be required.

If you're looking for purpose, teamwork, and a place where what you do truly matters, you've found it. Let's do big things together. Apply now and join our team.