Role Description The Denials Specialist will be responsible for researching, analyzing, resolving and trending rejections and/or denials specific to the revenue cycle. This includes, but is not limited to: - Analyzing specific denial categories and codes. - Researching the underlying reason for the denial. - Rectifying the issue in the patient management system. - Ensuring that the claim is adjudicated. The Denials Specialist should be able to: - Identify potential process improvement opportunities. - Offer recommendations for correcting issues. - Understand how various components of the revenue cycle can cause a denial. - Be a problem solver and utilize available resources to rectify a denial. Additional responsibilities include: - Analyzing Managed Care contracts and reconciling payments received. - Contacting insurance companies to have adjustments processed and/or file appeals. - Direct interaction with Managers and/or Department Heads regarding administrative issues related to rejections and/or denials. Qualifications - High school diploma, equivalent or higher. - 5 or more years of experience in billing, A/R follow up, denials management & appeal writing. Requirements - Proficient in payment review systems, hospital information systems and coding methodologies. - Strong quantitative, analytical and organizational skills. - Advanced understanding of an Explanation of Benefits (EOB). - Intermediate knowledge of CPT, ICD-10, and HCPCS coding standards. - Understand CMS Memos and Transmittals. - Understand medical records, professional claims, and the Charge master. - Utilize and understand computer technology. - Understand all ancillary charges and multi-specialty departmental functions. - Communicate orally and in written form. - Understand insurance terms and payment methodologies. - Work effectively with physicians, administrative staff, and department managers. - Identify accurate Revenue code(s), CPT codes, and HCPCS codes for services/items. - Identify clerical errors, mistakes in interpretation, imprecise records, and inaccurate service code assignment. - Perform reviews for appropriateness of coding and charging. Benefits - Pay Range: $24.69 - $35.99/hr - Remote role (based out of Greenville, NC) - Monday - Friday day shift: 8:00 a.m. - 5:00 p.m. ET - Great Benefits

Role Description This role is responsible for analyzing coding denials by insurance carriers, CPT code(s), and specialty area, review and submission of coding appeals related to denials to include coding, bundling, duplicate, and other assigned denial volume. As well as responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims and accounts. Perform detailed analysis on denied assigned claims with a focus on maximizing revenue and reimbursement. Utilizes provider documentation and queries, coding software tools and Insurance carrier medical and reimbursement policies during the claim review process. - Review and analyze coding, bundling, and duplicate denials including identification of root cause. - Resolve coding denials which include researching and reviewing payer coding guidelines, writing and submitting appeals with supporting documentation. - Analyzing assigned denials and making necessary corrections or modifications. - Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted. - Identify and provide coding denial trends by Payer, CPT code, or any other denial parameters. - Performs searches of governmental, payor-specific, guidelines to identify coding and billing requirements to make recommendations. - Analyzes data from various sources (medical records, claims data, payer medical policies, etc.), determines the causes for denials of payment and partners with management to implement strategies to prevent future denials. - Integrates the payer medical policies, case specific medical documentation, and claims information into a concise appeal letter, including appropriate medical records submission. - Performs timely review of medical records and remittances for denials in order to determine root cause and appropriateness. - Partners with revenue cycle leadership, peers and clinical operations to reduce denials. - Reviewing claim edits and denials and/or inquiries referred from other departments and assists in identifying root causes. - Investigates the validity of the reasons for the denials and determines the need for or feasibility of submitting appeals. - Attends coding conferences, workshops, and in house sessions to receive updated coding information and changes in coding and/or regulations. - Develop process improvement initiatives from which problems can be resolved. - Documents results of all special projects and provides recommendations for revenue managing opportunities. Qualifications - Minimum of bachelor's degree or higher in a health service-related discipline. - Five years of denial recovery experience or revenue cycle related field with a certificate in coding may be substituted. - Previous auditing experience preferred. - National Certification in an area relevant to Revenue Management or Coding is preferred. Requirements - Proficient in reimbursement methodologies, hospital information systems and coding methodologies. - Illustrates creative problem-solving skills through documentation of process improvement reporting and/or internal reporting mechanisms. - Ability to analyze complex medical records and identify billable services. - Strong quantitative, analytical, and organizational skills. - Understanding of medical records, professional/hospital claims, and the Charge master. - Ability to utilize and understand computer technology. - Ability to understand ancillary department functions. - Possesses a comprehensive knowledge of various payment and coding methodologies, including ICD-10, HCPCS and CPT-4 coding schemes. - Possesses a working knowledge of the UB-04/837 claim form loop and segments. - Understands charging, coding processes along with compliance issues. - Has the ability to provide resolutions by performing internet research, utilizing third party payor regulations, referencing coding guidelines, and referencing local Fiscal Intermediary and CMS guidelines. - Requires knowledge of medical terminology, anatomy and physiology. - Must be team-oriented with strong interpersonal skills. - Knowledge of the Privacy Act to safeguard patient confidentiality. - Certified Coding Specialist or Certified Procedural Coder. Benefits - Remote role (based out of Greenville, NC) - Monday - Friday day shift: Start/end times flexible between 6:00 a.m. - 6:00 p.m. - Great Benefits Company Description ECU Health is a mission-driven, 1,708-bed academic health care system serving more than 1.4 million people in 29 eastern North Carolina counties. The not-for-profit system is comprised of 13,000 team members, nine hospitals and a physician group that encompasses over 1,100 academic and community providers practicing in over 180 primary and specialty clinics located in more than 130 locations. The flagship ECU Health Medical Center, a Level I Trauma Center, and ECU Health Maynard Children’s Hospital serve as the primary teaching hospitals for the Brody School of Medicine at East Carolina University. ECU Health and the Brody School of Medicine share a combined academic mission to improve the health and well-being of eastern North Carolina through patient care, education and research.

Role Description We are seeking a detail-oriented and knowledgeable Medical Biller and Coder for Urgent Care and ER to join our healthcare team. The ideal candidate will be responsible for managing the billing process, ensuring accuracy in medical coding, and facilitating timely payments from insurance companies and patients. A strong understanding of medical terminology, coding systems, and collections is essential for success in this role. - Process medical billing claims accurately and efficiently using appropriate coding systems such as ICD-10 and ICD-9. - Review patient records to ensure all necessary information is included for billing purposes. - Verify insurance coverage and benefits prior to submitting claims to ensure proper reimbursement. - Follow up on unpaid claims and conduct medical collections as necessary. - Maintain accurate records of all billing transactions and communications with insurance companies and patients. - Collaborate with healthcare providers to resolve any discrepancies in billing or coding. - Stay updated on changes in medical billing regulations, coding practices, and insurance policies. - Utilize medical office systems effectively to manage billing processes and maintain patient confidentiality. Qualifications - Proven experience in medical billing, coding, or a related field is preferred. - Strong knowledge of medical terminology, DRG (Diagnosis Related Group), and various coding systems (ICD-10, ICD-9). - Familiarity with medical records management and the healthcare reimbursement process. - Excellent attention to detail with strong organizational skills. - Ability to communicate effectively with healthcare professionals, insurance representatives, and patients. - Proficient in using medical office software and billing systems. - Certification in medical billing or coding is a plus but not required. Requirements - ICD-10: 1 year (Required) Benefits - Dental insurance - Health insurance - Paid time off - Vision insurance

• Support our life-saving Lifeline products by using your medical billing and collecting experience to obtain maximum reimbursement while establishing strong relationships with insurance companies and customers. • Obtaining and entering Medicaid authorizations accurately and timely to ensure clean claims are released • Reviewing claims for the accuracy of procedures, diagnoses, demographic and insurance information • Obtaining and entering equipment upgrades and correspondence from the payer agencies • Reviewing and correcting all claims/charge denials and edits that are communicated via Explanation of Benefits (EOB) and other methods of communication • Monitoring days in Accounts Receivable and ensuring that they are maintained at the levels expected by management • Communicating proactively of any billing issues identified • Timely follow-up on billing and claims discrepancies as communicated by the payer. • Reading and interpreting insurance Explanation of Benefits • Responding to inquiries from agencies, case managers, insurance companies, and internal customers in a timely manner • Regularly attending monthly staff meetings and in-house training events • Additional duties and responsibilities as required and or assigned.