Follow up directly with commercial, governmental, and other payers to resolve claim payment issues and secure reimbursement
Identify and analyze denials, payment variances, and no response claims and draft/submit technical and clinical appeals
Support denial, no response, and audit activities
Document all activity accurately in client’s host system and/or tracking system
Maintain understanding of federal/state regulations and payer-specific requirements
Work with management to identify and address root causes in A/R
Demonstrate initiative, resourcefulness, and communicate trends to management
Requirements
Basic computer knowledge
Proficiency in Microsoft Excel
Excellent verbal skills
Problem solving skills and critical thinking
Ability to identify reasons for underpayments, denials, and payment delays
Ability to meet quality and productivity standards and attendance policies
Preferred: 2 or 4-year college degree
Preferred: 1+ years 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 and revenue cycle
Preferred: Experience with DDE Medicare system and payer websites
Preferred: Working knowledge of medical terminology and/or insurance claim terminology