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Job Summary: Are you an individual who thrives in an organization that is growing and evolving? Is the word “change” not scary to you? If so, we are looking for an individual such as yourself to join our team. You will be responsible for performing research and confirmation on denied hospital accounts, successfully working with insurance companies via phone as well as the preparation and writing of appeal letters and the associated follow up activities in order to obtain additional reimbursement for our Clients.

                     Duties and Responsibilities:

  • Research current state and Federal healthcare regulations.
  • Maintain a professional and HIPAA compliant work area.
  • Validate the accuracy of the denial and capture/document the detailed CAS code reason(s) and remark codes.
  • Based on the detailed finding of the denial, initiate all related and supporting documentation needed for inclusion in the appeal letter.
  • Identify if there is the need to include clinical team into the review and appeal process.
  • Research payer specific guidelines and contract language to include when applicable for appeal submissions.
  • Perform other required duties in a timely, professional, and accurate manner.
  • Conducts appropriate account activity on accounts by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online.
  • Continue collection activity until account is resolved.
  • Responsible for maintaining inventory and that daily productivity standards of assigned accounts are met.
  • Identify payor issues and trends and escalate issues to Management.
  • Ensure compliance with State and Federal Laws, Regulations for Managed Care and other Third Party Payors.
  • Participate with hospital clients on payer phone calls. 

Qualifications:

  • Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written.
  • Strong telephone communication skills are required.
  • Ability to prioritize work and meet deadlines is required.
  • Ability to operate common computer systems, utilize hospital collection system and business software is required.
  • Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements.
  • Intermediate understanding of ICD-9/10, HCPCS/CPT coding and medical terminology.
  • Intermediate Microsoft Office (Word, Excel) skills.
  • Advanced business letter writing skills to include correct use of grammar and punctuation.
  • Strong interpersonal skills.
  • Above average analytical and critical thinking skills.
  • Ability to make sound decisions.
  • Have an understanding of hospital collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements.
  • Familiar with terms such as HMO, PPO, IPA and Capitation Intermediate understanding of EOB, hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
  • Ability to be flexible and promote teamwork

Education/Experience:

  • Current J.D., in good standing.
  • Strong analytical skills and strong proficiency in Microsoft Office Tools.
  • 3-5 years Healthcare experience preferred.

Full Time Days

Required experience:

Healthcare: 3 years