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Denials Jobs in Georgia (NOW HIRING)

Trice Healthcare

Coding Payment Resolution Spec

Rex, GA · On-site

$17.25 - $22.25/hr

Coding Payment Resolution Specialist Responsible for reviewing all post-billed denials (inclusive of coding-related denials) for coding accuracy and appealing them based upon coding expertise and ...

Grady

PB Coder I

Atlanta, GA · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

Resolve coding-related denials to support accurate reimbursement. Quality Assurance & Productivity 5. Maintain Productivity & Quality Standards * Meet hourly productivity and accuracy standards set ...

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Denials information

What is the difference between Denials vs Claims Adjuster?

AspectDenialsClaims Adjuster
Primary RoleReview and process claims that have been denied or rejectedEvaluate and settle insurance claims, including approved and denied claims
Work EnvironmentInsurance companies, healthcare providers, or third-party administratorsInsurance companies, public agencies, or independent firms
Required CredentialsKnowledge of insurance policies, coding, and claims processing; certifications varyAdjuster licenses, insurance knowledge, and sometimes certifications

In summary, Denials specialists focus on identifying and managing denied claims, while Claims Adjusters handle the entire claims process, including approved and denied cases. Both roles require insurance knowledge, but their primary functions differ in scope and responsibility.

What are denials in healthcare billing?

Denials in healthcare billing refer to claims that have been submitted to an insurance company but are rejected or not paid. Denials can occur for various reasons, such as missing information, incorrect coding, or eligibility issues. Handling denials is an essential part of the revenue cycle in healthcare organizations, as it ensures providers receive proper reimbursement for their services. Effective denial management involves identifying the cause, correcting errors, and resubmitting claims to maximize revenue.

What are the typical challenges faced in a denials specialist role, and how can they be managed effectively?

A Denials Specialist often encounters challenges such as high volumes of denied insurance claims, navigating complex payer requirements, and communicating effectively with both insurance companies and internal teams. Managing these challenges requires strong attention to detail, persistence in follow-up, and up-to-date knowledge of billing codes and payer policies. Building strong relationships with payers and collaborating closely with billing and coding teams can help resolve denials efficiently and prevent future occurrences, making teamwork and proactive problem-solving critical skills in this role.

What are the key skills and qualifications needed to thrive as a denials specialist?

To thrive as a Denials Specialist, you need a thorough understanding of medical billing, insurance policies, and claims adjudication, often supported by a background in healthcare administration or a related field. Familiarity with practice management software, electronic health records (EHRs), and coding systems such as ICD-10 and CPT is typically required. Strong analytical skills, attention to detail, and effective communication help you resolve complex denials and collaborate with providers and payers. These competencies are vital for maximizing reimbursement, reducing claim rejections, and ensuring the financial health of healthcare organizations.
What are the most commonly searched types of Denials jobs in Georgia? The most popular types of Denials jobs in Georgia are:
Denials jobs near you

DENIALS MANAGEMENT ANALYST, REVENUE CYCLE MEDICAL GROUP

SGMC Health

Valdosta, GA • On-site

Full-time

Medical, Life, Retirement, PTO

Re-posted 18 days ago

Job description

Description
WHAT IT'S LIKE AT SGMC HEALTH
Purpose. No matter your role or area that you work in, at SGMC Health we are collectively working towards goals that will make our community a better place.
Excellence. We strive to do the right thing the right way, are accountable in all we do, require competence of our people, and are compassionate in our service.
Team Spirit. We encourage team effort, support personal and professional development, acknowledge individual talents and skills, and support innovation and empowerment.
Award Winning Performance. We are committed to providing the best care possible and we are proud to be recognized locally, statewide, and nationally for the exceptional care that our staff provides.
WHY YOU WILL LOVE SGMC HEALTH
SGMC has great benefit options, depending on the role that you are going into- including healthcare, supplementary benefits, ways to save for the future, opportunities for career advancement, and opportunities to expand your skill set. Some of these great benefit options are listed below:
  • Low Healthcare Insurance Premiums
  • 401(k) with employer match
  • Paid Time Off (PTO)
  • Employee discounts
  • Company paid life insurance
  • Short-Term and Long-Term Disability
  • Cancer Insurance
  • Accident Insurance
  • Pet Insurance
  • Tuition Reimbursement
  • On-the-job training and skills development
  • Opportunities for growth and advancement
  • Employee Assistance Program

JOB LOCATION : SGMC Patient Financial Services
DEPARTMENT: REVENUE CYCLE MEDICAL GROUP
SCHEDULE: Full Time, 8 HR Day Shift, 8-5
POSITION SUMMARY
The Denials Management Analyst is responsible for thorough understanding of existing and future managed care payment methodologies such as fee for service and fee schedule in order to effectively analyze zero paid, underpaid, overpaid, and denied insurance claims. The analyst is responsible for timely and accurately interpreting all payer contracts and regulations to determine the correct payer denial. Responsible for determining the optimal combination of rebilling, collections, and follow-up activities to ensure correct reimbursement to include extensive phone, fax, and written correspondence with payers. This includes coordination with all payers, Professional Coders, Billers, Patient Access Services, Finance, Accounting and other departments as necessary. This position is responsible for timely and accurately reviewing and trending all payer contractual adjustment variances. Responsible for preparing all necessary support information, education material for clinic staff and providers. Responsible for identifying trends in denials. Daily review of claims to determine appropriate appeal or claim reprocessing/reconsiderations to represent correct processing of insurance claims. Responsible for knowing all timely filing deadlines for each designated payer and prioritizing denials appropriately.
KNOWLEDGE, SKILLS & ABILITIES
  • Technical/system skills/knowledge: PC and Windows literacy required; prefer knowledge of, or experience with, EPIC PB Resolute and Microsoft Office applications with strong knowledge of Microsoft Excel required.
  • Extensive knowledge of insurance/managed care, to include: Medicare; Medicaid (Georgia); Medicaid CMO's,Tricare (Standard, Extra and Prime); VA; Medicare Managed Care; Blue Cross (Georgia, Florida, out-of-state and FEP) and other commercial managed care plans.
  • Working knowledge of CPT-4, HCPCS, and ICD-10.
  • Reimbursement methodologies: percent of charges; fee-for-service; and fee schedule. • Must have a thorough understanding and knowledge of: patient type; financial class; place of service codes; and relationship codes;
  • Related regulatory and legal requirements: Medicare Secondary Payer Questions; medical necessity; Medical Reviews and Appeals. • Interacts with: patients; other departments; physician offices; acute medical care providers; insurance companies; employers; Medicare administrative contractors; utilization review companies; state regulatory agencies, GMCF, Medicaid.
  • Knowledge of medical terminology.
  • Strong verbal/written communication skills.
  • Highly organized with the ability to prioritize work.
  • College degree or coursework preferred.
  • CPAR preferred
  • Types 40 wpm accurately.
  • Clinical background beneficial.
  • Professional coding background preferred.
WORKING CONDITIONS - ADA INFORMATION
Modern, well lighted, air conditioned, general work area. Moderate noise level. Occasional overtime required. Ability to sit, stand or walk for moderate periods. Safe and efficient operation of office equipment including: copier, fax, printers, computer, telephone, adding machine, Medifax, credit card machine, typewriter, paper shredder. Reading of printed materials, including physician orders. Listening and verbally responding to customers, staff, physicians and visitors. Moderately heavy lifting {0-25 lbs.}, reaching, stooping, pushing, pulling, bending, and twisting.
SEE WHAT ALL OF THE HYPE IS ABOUT
https://www.youtube.com/watch?v=_DeqKw8xk54

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