Operations Oversight Analyst
Gold Coast Health Plan
Accounts Receivable Resolution Specialist
Connections Health Solutions
full-time
Posted on:
Origin: • 🇺🇸 United States • Virginia
Visit company websiteJob Level
Mid-LevelSenior
About the role
- Assuring that accounts have been properly billed and reimbursed
- Contacting the appropriate insurance company to secure and expedite payments through the follow-up and appeals resolution processes
- Acting as a functional leader or reference source
- Providing the link in communication between Connections Healthcare Solutions and the patient, insurance companies/third-party payers, and the provider of service or departmental staff
- Following up on required daily accounts based on leadership assignments to reduce the A/R
- Performing timely and accurate validation of denied claims and determining appropriate denial resolution, including but not limited to; authorization/retro authorization/precertification
- Utilizing WAYSTAR to submit appeal letters and payer-required documentation on unpaid and underpaid claims
- Prioritizing work to increase efficiency in the collections process
- Documenting action taken toward account resolution within Avatar and WAYSTAR using standardized note format
- Meeting productivity requirements as set within the department
- Effectively communicating identified opportunities with leadership utilizing SBAR format
- Participating in coordinated departmental initiatives related to AR reduction
- Taking initiative to troubleshoot technological issues and communicating to leadership according to department guidelines
- Assisting billing with determining the proper disposition of or composing replies to incoming mail and other correspondence
- Performing all other duties as assigned.
Requirements
- High School diploma, GED, or international equivalent
- 2 years of insurance claims follow-up
- 2 years of claim denial management
- 5 years of experience within a physician and/or facility business office
- 1 year of experience working in a remote environment
- The Company has a mandatory vaccination policy. All successful applicants must be fully vaccinated, including showing proper documentation, or otherwise be exempt pursuant to the Company’s exemption process prior to their start date as a condition of employment
- It would be great if you had: Bachelor's degree in health care or related field
- It would be great if you had: 5 years of experience with physician and/or facility billing/auditing within a behavioral health environment
