Job Description:
• Following up directly with commercial, governmental, and other payers to resolve claim payment issues.
• Securing appropriate and timely reimbursement and response.
• Identifying and analyzing denials, payment variances, and no response claims and acts to resolve claims/accounts.
• Drafting and submitting technical and clinical appeals.
• Providing support for all denial, no response, and audit activities.
• Examining denied and other non-paid claims to determine the reason for discrepancies.
• Communicating directly with payers to follow up on outstanding claims.
• Files technical and clinical appeals, resolves payment variances, and ensures timely and accurate reimbursement.
• Works with management to identify, trend, and address root causes of issues in the A/R.
• Maintaining a thorough understanding of federal and state regulations, as well as payer specific requirements and takes appropriate action accordingly.
• Documenting all activity accurately including contact names, addresses, phone numbers, and other pertinent information in the client’s host system and/or appropriate tracking system.
• Demonstrating initiative and resourcefulness by making recommendations and communicating trends and issues to management.
Requirements:
• Must demonstrate basic computer knowledge and demonstrate proficiency in Microsoft Excel.
• Excellent Verbal skills.
• Problem solving skills, the ability to look at accounts and determine a plan of action for collection.
• Critical thinking skills, the ability to comprehend tools provided for securing payment, and apply them to differing accounts to result in payment.
• Adaptability to changing procedures and growing environment.
• Meet quality and productivity standards within timelines set forth in policies.
• Meet required attendance policies.
• Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences.
• 2 or 4-year college degree preferred.
• 1 or more years of relevant experience in medical collections, physician/hospital operations, AR Follow-up, denials & appeals, compliance, provider relations or professional billing preferred.
• Knowledge of claims review and analysis.
• Working knowledge of revenue cycle.
• Experience working the DDE Medicare system and using payer websites to investigate claim statuses.
• Working knowledge of medical terminology and/or insurance claim terminology.
Benefits:
• Remote Role
• Bonus Incentives
• Paid Certifications
• Tuition Reimbursement
• Comprehensive Benefits
• Career Advancement