About this role
Job Summary:
- Analyzes claim denials and executes follow up to recover payment
- Assists with provider credentialing and payor enrollment to maintain provider status and research denials
- Coordinates with multiple departments as needed to determine the root causes of denials
- Maintains a tracking log to monitor post-payment review findings and appeals
- Identifies patterns in payor denials and reports recurring issues to management
- Assists with claim submission, follow-up, and reporting needs throughout the clinically driven revenue cycle
- Submits payer reconsiderations and appeals as necessary and completes follow-up for final resolution
- Assists in the clinical revenue cycle to achieve the maximum appropriate reimbursement
- Retrieves paper and electronic claims and remittance advice reports where necessary to overcome denials
- Enters accurate and thorough documentation of pertinent events regarding the handling of the denial
- Meets established production standards
- Works in a collaborative fashion with the office, billing, and coding staff to improve overall processes
Qualifications
Education:
High school diploma required. Some college coursework in a healthcare, business, or related field preferred.
Experience:
Minimum three (3) years working in Medical Billing.
Additional Skills/Abilities:
Must be self-directed / self-motivated; must have good communication and interpersonal skills. Must be able to: (1) perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure; (2) work independently; (3) recognize the rights and responsibilities of patient confidentiality; (4) relate to others in a manner which creates a sense of teamwork and cooperation; and (5) maintain a customer focus and strive to satisfy the customer's perceived need.