Senior Appeal and Denial Specialist - Remote

Role Overview

The Senior Appeal and Denial Specialist plays a critical role in ensuring that Sanford Health receives appropriate reimbursement for the services it provides. This position involves a deep understanding of clinical guidelines, payer regulations, and the appeals process. The specialist leverages clinical expertise to review medical records, determine medical necessity, and advocate for patients by ensuring denials are appropriately appealed. This role is essential for maintaining financial health and compliance within the organization.

Day in the Life

A typical day for a Senior Appeal and Denial Specialist includes:

• Reviewing denied claims and medical records to determine the basis for the denial.
• Applying clinical knowledge and established criteria to assess the medical necessity of services.
• Preparing and submitting appeals to insurance companies, ensuring all necessary documentation is included.
• Tracking the status of appeals and following up with payers as needed.
• Collaborating with physicians and other healthcare professionals to gather additional information to support appeals.
• Staying up-to-date on changes in payer regulations and guidelines.
• Identifying trends in denials and working with the team to develop strategies to prevent future denials.
• Providing guidance and mentorship to other team members.
• Participating in meetings and training sessions to enhance knowledge and skills.

Why Remote SD/WI

The remote nature of this position offers several advantages. Remote work provides flexibility and allows for a better work-life balance, reducing commute times and offering the ability to work from the comfort of your home. This can lead to increased job satisfaction and productivity. Additionally, working remotely allows Sanford Health to tap into a wider pool of talent, attracting experienced specialists who may not be located near a physical office. For individuals in South Dakota and Wisconsin, this role offers a chance to contribute to a leading healthcare system while remaining in their communities.

Career Path

The Senior Appeal and Denial Specialist role offers several paths for career advancement within Sanford Health. Experienced specialists can move into leadership roles, such as team lead or supervisor, overseeing the appeals and denials process for a larger team. There are also opportunities to specialize in a particular area, such as Medicare or Medicaid appeals. Additionally, the skills and knowledge gained in this role can be a valuable asset for roles in compliance, risk management, or revenue cycle management. Continuous professional development and training are encouraged to help employees reach their career goals.

Salary & Benefits

The estimated salary range for a Senior Appeal and Denial Specialist at Sanford Health is $55,000 to $85,000 per year. This range is based on experience, education, and certifications. In addition to competitive pay, Sanford Health offers a comprehensive benefits package, including:

• Comprehensive health insurance
• Dental and vision insurance
• Prescription drug coverage
• Health savings account (HSA)
• Flexible spending accounts (FSA)
• Paid time off (PTO)
• Paid holidays
• Retirement plan with employer match
• Life insurance
• Disability insurance
• Employee assistance program (EAP)
• Wellness programs
• Tuition reimbursement
• Professional development opportunities
• Employee discounts

Sanford Culture

Sanford Health is committed to creating a culture of health and healing. The organization values teamwork, innovation, and a patient-centered approach. Employees are encouraged to contribute their ideas and perspectives, and are provided with opportunities for growth and development. Sanford Health also places a strong emphasis on community involvement and giving back to the areas it serves.

How to Apply

Interested candidates can apply for the Senior Appeal and Denial Specialist position through the Sanford Health careers website. The application process typically involves submitting a resume and cover letter, as well as completing an online application. Qualified candidates will be contacted for an interview.

FAQ

1. What qualifications are required for this role? A bachelor's degree or a combination of applicable degree completion and applicable experience is required. A graduate degree from a nationally accredited nursing program is preferred.
2. Is this a remote position? Yes, this position is fully remote for candidates residing in South Dakota or Wisconsin.
3. What are the typical working hours? The position involves 8-hour day shifts, totaling 40 hours per week.
4. What are the main responsibilities of the Senior Appeal and Denial Specialist? The main responsibilities include reviewing denied claims, preparing and submitting appeals, tracking appeal statuses, and collaborating with healthcare professionals.
5. What skills are important for success in this role? Important skills include clinical expertise, knowledge of payer regulations, strong communication skills, and the ability to work independently.
6. What opportunities for career advancement are available? Career advancement opportunities include team lead, supervisor, and specialization in areas such as Medicare or Medicaid appeals.
7. What benefits does Sanford Health offer? Sanford Health offers a comprehensive benefits package including health insurance, dental insurance, vision insurance, paid time off, and a retirement plan with employer match.
8. What is the company culture like at Sanford Health? Sanford Health values teamwork, innovation, and a patient-centered approach. Employees are encouraged to contribute their ideas and perspectives, and are provided with opportunities for growth and development.
9. How do I apply for this position? Interested candidates can apply through the Sanford Health careers website.
10. What is the salary range for this position? The estimated salary range for this position is $55,000 to $85,000 per year.