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Named among "Great Places to Work" by Becker's Hospital Review Career Growth Opportunities Convenience market on site Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment 401K program (Discretionary matching funds available) Employee Assistance Program Referral Program Dental plans & Vision plans GENEROUS Personal time off Eight Paid Holidays per year Quarterly incentive plans Business casual dress code Free Parking Free coffee daily Employee of the month awards with monetary gift and parking space Training Programs Fitness Center with personal trainer on site Awesome Facility with terrific amenities Wellness programs Flexible work schedule JOB DESCRIPTION OVERVIEW:
This position is responsible for reviewing carrier denials from Medicaid, Medicare, Blue Cross Blue Shield, Managed Care, and Commercial Insurances and is responsible to file appeals as needed. Maintains accuracy and production to ensure remittances are being processed effectively and appeals are resolved through payment.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Reviews EOB's and enters rejection codes, comments, and rebills claim as necessary. Reviews denials to determine appropriate action based on carrier requirements. Assembles and forwards documentation to appeal disputed claims. Contacts Medicare, Medicaid, Managed Care, Commercial, and Blue Cross Blue Shield to inquire on claims. Assembles and forwards appropriate documentation to the senior representative for provider related issues and claim spec issues. Reviews Medicaid, Medicare, Managed Care, and Blue Cross Blue Shield provider manuals and updates. Reports any consistent errors found during review that affect claims from being processed correctly. Turns to supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc. Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager. QUALIFICATIONS / EXPERIENCE: High school diploma or equivalent required; Previous medical billing experience preferred with primary emphasis on denial research; Knowledge of Physician Billing Policies and Procedures across multiple states; Excellent communication skills both oral and written; Good computer skills with proficiency in Microsoft Outlook, Excel, Word, GE Centricity Business/ETM; Ability to meet deadlines; Ability to work overtime as needed. SUPERVISORY RESPONSIBILITIES: None PHYSICAL / ENVIRONMENTAL DEMANDS:
This job should be performed in a well-lighted and well-vented environment. Requires constant sitting tolerance. Extended amount of time spent in front of computer display terminal.
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production and quality standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
DISCLAIMER:
Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.
