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.