Top 51 Claims specialist Jobs in Winston Salem Nc

Physician Appeals Specialist
Atrium Health —Winston-Salem, NC
- $26.55 - $39.85 an hour
- Full-time
- Anatomy knowledge
- High school
- Computer literacy
- Paid parental leave
- Disability insurance
2d
Mail Room Specialist I
EMS Management & Consultants Inc —Winston-Salem, NC
- Extended hours
- HIPAA
- Office
- High school diploma or GED
5d
Customer Experience Specialist I
Liberty Hardware —Winston-Salem, NC
- $18.05 - $28.33 an hour
- Full-time
- Hybrid work
- Spanish
- 5 years
- Research
Patient Services Specialist - Winston Salem
OrthoCarolina —Winston-Salem, NC
- Full-time
- HIPAA
- High school diploma or GED
- Clinic
- Paid holidays
- Tuition reimbursement
Quick Apply
9d
Security Professional Flex Officer
Allied Universal —Winston-Salem, NC
- $22.66 an hour
- Part-time
- 18 years or older
- 5 years
- Military
- AD&D insurance
- Paid holidays
Quick Apply
4d
Regulatory Affairs Specialist
Charter Medical, LLC —Winston-Salem, NC
- Monday to Friday
- Mid-level
- 3 years
- Communication skills
- Disability insurance
- Health insurance
Quick Apply
Launch & Enablement Specialist
GT Independence —High Point, NC
- $100,000 a year
- Hybrid work
- Mid-level
- Microsoft Office
- Organizational skills
- Health insurance
- Paid time off
Quick Apply
Employee Benefits Specialist
Brown & Brown —Greensboro, NC
- Full-time
- Microsoft Excel
- Office
- Windows
- Employee stock purchase plan
- Paid holidays
Technical Specialist
National Truck Protection —Winston-Salem, NC
- Full-time
- Spanish
- Mechanic experience
- Data analysis skills
Accounts Receivable & Collections Specialist
Paul Davis of Piedmont, Triad West, & Mountain Regions, NC —Winston-Salem, NC
- $24 - $28 an hour
- Full-time
- Pass drug screening
- Mid-level
- Office
- Paid training
- Health insurance
Quick Apply
12d
Bilingual Account Resolution Specialist | Financial Services | Entry Level (Greesboro)
Vanderbilt Mortgage —Greensboro, NC
- $22.43 - $23.93 an hour
- Full-time
- Background check
- Spanish
- English
- Health insurance
- Dental insurance
Quick Apply
10d
Senior Specialist, Operations OSD
XPO —Kernersville, NC
- OSHA
- Ability to walk for extended periods
- Pass drug screening
Quick Apply
11d
Carrier Compliance Specialist
EPES LOGISTICS SERVICES INC —Greensboro, NC
- Full-time
- Microsoft Excel
- Pass drug screening
- Office
2d
Acquisition Specialist - State Farm Agent Team Member
Jennifer Buckley - State Farm Agent —Greensboro, NC
- $40,000 - $60,000 a year
- Full-time
- Office
- Business development
- Communication skills
- Paid time off
- Opportunities for advancement
Quick Apply
Acquisition Specialist - State Farm Agent Team Member
Dakota Andrews - State Farm Agent —Greensboro, NC
- $20 - $32 an hour
- Full-time
- Office
- Business development
- Communication skills
- Paid time off
- Opportunities for advancement
Quick Apply
Payroll Specialist
FURNITURELAND SOUTH INC —Jamestown, NC
- $26 an hour
- Full-time
- Mid-level
- Office
- Finance
- 401(k)
Quick Apply
9d
Customer Relationship Specialist-Full Time
Victory Arms & Munitions, LLC —Mocksville, NC
- $15 - $18 an hour
- Full-time
- Microsoft Word
- Mid-level
- Organizational skills
- Profit sharing
- Paid time off
Installer Service Specialist
O'Reilly Automotive Stores —Winston-Salem, NC
- Full-time
- ASE Certification
- Mid-level
- Team management
- Employee stock purchase plan
- Health insurance
Quick Apply
Inventory Specialist
Walgreens —Greensboro, NC
- $17 - $20 an hour
- Weekends as needed
- Merchandising
- English
- Mid-level
6d
Commercial Lines Claims Intake Specialist
Mountcastle Insurance —Lexington, NC
- $14 - $16 an hour
- High school diploma or GED
- Organizational skills
- Associate's degree
Quick Apply

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Physician Appeals Specialist

Atrium Health -
Winston-Salem, NC

Apply Now

Job Details

Full-time
$26.55 - $39.85 an hour
2 days ago

Benefits

Paid parental leave
Disability insurance
Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Paid time off
Adoption assistance
Parental leave
Vision insurance
Retirement plan

Qualifications

Anatomy knowledge
Research
Clinical information systems
Health information management
Productivity software
Medical terminology

Full Job Description

Department:

13229 Enterprise Revenue Cycle - Rev Recovery and Audit Mgmt

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

Schedule Details/Additional Information:

Mon-Fri

Pay Range:

$26.55 - $39.85

Major Responsibilities:

Escalated review of medical documentation at an advanced level from clinicians, qualified health professionals and hospitals to validate medical necessity of the service rendered. Ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations and EMR and/or payer guidelines.
Appeal advanced levels of medical appeals with insurance payers to recovery denied payment while validating the integrity of the coded charges and billed claim.
Reviews all clinician documentation to support assigned codes in the health information record so that all significant diagnoses and procedures may be captured for reimbursement and data purposes.
Conduct independent research to promote knowledge of coding guidelines, regulatory policies and trends.
Provide education to Providers in denial practices and payer medical policies.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in reviewing codes for proper insurance reimbursement.
Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
Recommend modifications to current policies and procedures as needed to coincide with government regulations.
Responsible for processing medical necessity Claim Denials, when applicable
Responsible for appropriate appeal of denied claims utilizing professional coding oversight.

Certification Required:

Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)

Education Required:

Advanced training beyond High School in Medical Coding or related field or equivalent knowledge/experience

Work Experience Required:

Typically requires 3 years of experience in professional coding including experiences in either hospital or professional revenue cycle processes and health information workflows.

Knowledge, Skills & Abilities Required:

Advanced knowledge of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
Intermediate computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
Advanced communication (oral and written) and interpersonal skills.
Advanced organization, prioritization, and reading comprehension skills.
Advanced analytical skills, with a high attention to detail.
Ability to work independently and exercise independent judgment and decision making.
Ability to meet deadlines while working in a fast-paced environment.
Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

Exposed to a normal office environment.
Must be able to sit for extended periods of time.
Must be able to continuously concentrate.
Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance

Benefits and more

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

The Physician Appeals Specialist is responsible for the validation of coding of physician billed services, including inpatient and outpatient procedures for all billable clinicians, ensuring that claims are submitted to insurance payers in the most compliant, efficient and expeditious manner possible. This position is accountable for accurate review and appeal of clinical and non-clinical information to create a comprehensive database of information for billing purposes, internal data management, and external reporting of data. This position has a direct financial impact.

Apply Now

Refine Your Search

claims specialist jobs in winston salem nc

Physician Appeals Specialist

Mail Room Specialist I

Customer Experience Specialist I

Patient Services Specialist - Winston Salem

Security Professional Flex Officer

Regulatory Affairs Specialist

Launch & Enablement Specialist

Employee Benefits Specialist

Technical Specialist

Accounts Receivable & Collections Specialist

Bilingual Account Resolution Specialist | Financial Services | Entry Level (Greesboro)

Senior Specialist, Operations OSD

Carrier Compliance Specialist

Acquisition Specialist - State Farm Agent Team Member

Acquisition Specialist - State Farm Agent Team Member

Payroll Specialist

Customer Relationship Specialist-Full Time

Installer Service Specialist

Inventory Specialist

Commercial Lines Claims Intake Specialist

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