Descripción del puesto
In this role, the candidate will be responsible for validating disputes presented on EOBs, escalating and pursuing payment and analyzing variance trends.
Responsibilities:
• Reviews and validates EOBs, denial reasons, carrier and ensures coding is accurate and reflects the denial reasons
• Coordinates and plays role with clinical consultations when necessary
• Generate an appeal based on the dispute reason and contract terms specific to payer
• Prepare and submit insurance claim appeal letters
• Follow specific payer guidelines for appeals submission
• Escalate exhaustive appeal efforts for resolution
• Work payer projects as directed
• Coordinate and document status of appeals until final resolution of the denial
• Track and monitor increases in revenue from appeals process
• Identify denial & variance trends including internal collaboration to create the data analysis and data input methods
• Document the status of action steps taken to resolve outstanding claims
• Identify billing errors for correction and re-submission to insurance companies
• Follow up on payment errors, low reimbursement, and denials
• Identify and propose recommendations for improving workflow management
• These duties and responsibilities are not the full scope of the job description and are subject to change upon company demand.
Additional tasks may be assigned from time to time dependent on current or projected business need.
Requisitos
• 4+ years of Accounts Receivable follow up with health insurance carriers on claims (direct contract with insurers)
• Experience and insightful to issues with payment issues with providers operating outside of contractual payer agreements (out-of-network).
• Full understanding of the insurance denials / appeals process
• Excellent computer skills and especially proficient in utilizing Microsoft Office tools Excel, Outlook, Word, PowerPoint.
• Self-motivated, ability to work independently and work with remote colleagues
• Out of the box thinker to determine best ideas for department improvements
• Ability to work with a sense of urgency
• Comfortable working in a high-stress environment
• Comfortable communicating via phone calls, video calls, as well as via email
• Ability to manage time and prioritize tasks without direct supervisor’s input
• Highly organized and detail oriented
• Strong oral and written communication skills
• Exhibit professionalism and trustworthiness.
• High School Diploma or GED
Beneficios
Paid Health & Life Insurance
Perfect Attendance Bonus (Paid Monthly)