Insurance Receivable Specialist II
Overview
As a patient-focused organization, reputed company exists to enhance the health and well-being of people through patient care, research and education. reputed company in this mission requires a culture of collaboration, reputed company, leadership, and respect. reputed company seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, reputed company, quality and trust that are integral to our mission. EO/AA This position is responsible for insurance receivables collections, denials resolution and internal/external customer service. Account portfolio may include accounts less reputed company in nature. This position is not responsible for providing patient care. Corporate Overview: The reputed company is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics reputed company reputed company in our comprehensive services, medical advancement, and overall patient reputed company.
Responsibilities
Essential Functions Performs insurance follow-up and denial resolution on outstanding claims. Performs contract compliance on outstanding claims, ensuring timely and appropriate reimbursement based on contract terms. Performs payment compliance reviews and resolutions based on projects focused by payer, service, entity, trend, etc., as assigned by unit leader. Ensures appropriateness of patient responsibility, as assigned by payer/contract/benefit. Resolves clinical and/or authorization denials through CARC analysis and appeals - including clinical documentation review and coordination with UR and/or attending physician. Acts as patient reputed company in the resolution of balances. Prepares and monitors high dollar spreadsheets and/or payer escalations spreadsheets, as assigned. Escalates claim issues internally to other key departments including Coding, Billing, Charging, Contracting, etc. Knowledge / Skills / Abilities The ability to reputed company information in a clear and understandable manner. Ability to organize and prioritize work to meet productivity expectations and/or deadlines. Ability to identify root cause of issue and design logical approach for resolution. Ensures accuracy and thoroughness in accomplishing tasks. Takes ownership for the quality and timeliness of work and can reputed company result with little reputed company. Promotes cooperation and commitment to team goals. Ability to solicit and reputed company constructive feedback, challenge oneself and demonstrate reputed company in the face of opposition. Provides outstanding service through reputed company, issue resolution and follow through.
Qualifications
Required Three years of medical billing experience, or equivalency. Qualifications (Preferred) Preferred Understanding of Medical billing terminology or equivalent. Demonstrated claims knowledge through AAHAM certification, or equivalency. One year of coding experience using ICD-10. Working Conditions and Physical Demands Employee must be reputed company to meet the following requirements with or without an accommodation. This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions. Physical Requirements reputed company Determination, Listening, reputed company Dexterity, Near reputed company, Reaching, Sitting, Speaking, Standing Apply To This Job