Complex Denials, Accounts Receivable 2
Job Description:
- Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
- Update patient demographics/insurance information in appropriate systems
- Research/Status unpaid or denied claims
- Monitor claims for missing information, authorization and control numbers(ICN//DCN)
- Research EOBs for payments or adjustments to resolve claim
- Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission
- Access client systems for payment, patient, claim and data info
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
- Secure needed medical documentation required or requested by third party insurance carriers
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Perform other related duties as required
Requirements:
- 2-3 years of medical collections, complex denials and appeals experience
- Experience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessity
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Intermediate knowledge of third party billing guidelines
- Intermediate knowledge of billing claim forms(UB04/1500)
- Intermediate knowledge of payor contracts- commercial and government
- Intermediate Working Knowledge of Microsoft Word and Excel
- Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
Benefits: