Denials Management Specialist at Sheridan Memorial Hospital – Sheridan, Wyoming

SHERIDAN MEMORIAL HOSPITAL

At Sheridan Memorial Hospital, we proudly rank in the top 13.6% of U.S. hospitals, recognized by the Centers for Medicare and Medicaid Services. With over 850 dedicated employees and 100+ expert providers across 25 specialties, we are committed to exceptional, patient-centered care. Set in northern Wyoming’s stunning Big Horn Mountain foothills, Sheridan offers outdoor adventure and community charm. Our hospital combines cutting-edge technology with a collaborative, innovative culture. Join a team that values your skills, fosters growth, and empowers you to impact lives meaningfully. Apply today and be part of Sheridan Memorial Hospital’s mission of excellence!

JOB SUMMARY

• Under general direction, the position will review denied claims and appeal when necessary.


• Knowledgeable with payers including Managed Care, Commercial, Medicare and Medicaid.


• Prepare appeals related to denied services.


• Capable of reviewing explanation of benefits (EOB) from payors to determine how the claims were handled.


• Contact insurance carriers to check on the status of claims, appeals, mailing, registration, and insurance verification

ESSENTIAL JOB FUNCTIONS

• Reviews denied claims for categorization, level of appeal, and special requirements for initiating appeals.


• Utilized denial reports to assess root causes and identify trends. Share findings with stakeholders.


• Contacting payers, via website, phone and/or correspondence, regarding reimbursement of unpaid accounts.


• Interpret Managed Care contracts and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection.


• Make necessary adjustments as required by plan reimbursement.


• Verifies accurate encounter information by working Edit Failure Working in Cerner, making necessary corrections to insure timely claim submission.


• Monitors denied claims in Assurance correcting edits as need to insure claim submission and reimbursement.


• Contacts patients when additional information is required to file an insurance claim or when the insurance company has requested additional information from the member


• Processes correspondence and Explanation of Benefits in a timely manner.


• Processes overpayment refunds as required.


• Timely in making contact with insurance companies on claims that have exceeded the time expectation for payment.


• Remains current on Worker’s Compensation and other third party payors for billing functions.


• Demonstrates the ability to be flexible, organized and function well in stressful situations.


• Interacts with patients/families in a professional manner. Provides explanations regarding statements, insurance coverage.


• Treats patients/families with respect; ensures confidentiality of patient records.


• Maintains a good working relationship within the department and with other departments.


• Maintains a professional working relationship with insurance companies.


• Performs other duties as assigned.


• Ensures documentation meets standards and policies.

POSITION QUALIFCATIONS

Education, Experience & License

• High school diploma or general equivalency diploma (GED).


• Two or more years in hospital billing, preferred.

Additional Skills

• Ability to communicate in English, both verbally and in writing.


• Other languages preferred.


• Thorough understanding of Medicare, Medicaid, HMO's, PPO's, private insurance companies.


• Basic computer knowledge, data entry skills.