Job Description
- Job Description:
- Review denied claims based on assigned markets, payers and work queues within our practice management system
- Accurately and efficiently processes requests for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid insurance payers
- Researches and responds to documentation requests from insurance carriers in a timely manner
- Processes appeals of insurance denials and follows-up until the appeal is resolved
- Obtains, reviews and updates patient demographics and insurance information within both EHR and practice management billing system as needed
- Complete timely follow-up on claims submitted to payer, but no response or ERA after 45 days to resolve any pending issues with claim and payer within timely filing limits
- Documents clear and concise activities performed in the system for each account worked
- Adheres to all HIPAA (Health Insurance Accountability and Portability Act) guidelines and regulations
- Ability to consistently maintain productivity and quality expectations as defined by the leadership team
- Alert management to irregularities, insurance trends and areas of concern with reimbursement
- Completes other tasks and projects as assigned by RCM Leadership
- Requirements:
- Bachelor's Degree or Equivalent experience
- 3 or more years of experience in physician group practice in a denial management role
- Prior experience resolving out of network denials, and value based (bundle) claims
- Proficient in CPT and ICD-10 coding terminology
- Enjoy working in a fast paced and rapidly changing environment
- Strong relationship building skills both external and internal
- Thrive on working independently
- Benefits:
- We’re a recovery-friendly workplace that values family life, diversity, equity, and inclusion.
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