About the role
DUTIES AND RESPONSIBILITIES
Research unpaid claims, determine denial root cause, and perform appropriate follow up actions to ensure timely claim adjudication.
Identify and take appropriate action for the billing of secondary or tertiary insurances.
Keeps informed on all current applicable third-party payer regulations and requirements.
Communicates payer trends and patterns to management.
Document within a patient’s record all actions taken related account resolution.
Review, comprehend and execute payer logic within negotiated contracts.
Prioritize workflow to reduce or eliminate bad debt flow resulting in a reduction in days in AR.
Meet and maintain productivity and audit standards.
Other duties as assigned by management.
QUALIFICATIONS
EDUCATION
High School Diploma or equivalent.
EXPERIENCE
2-3 years of medical collections experience preferred.
LICENSE(S)/CERTIFICATION(S)
None.
KNOWLEDGE/SKILLS/ABILITIES
Results oriented & thrives in a fast-paced, high-energy environment.
Ability to develop and maintain good communication and establish positive working relationships with payers, peers, and leadership.
Strong written and verbal communication skills.
Knowledge of medical terminology, CPT and HCPCs.
Proficient in analyzing claims to ensure reimbursement aligns with contractual obligations.
Ability to organize work and manage change.
CORE COMPETENCIES
N/A
WORKING CONDITIONS
PHYSICAL REQUIREMENTS
Physical Requirements
Talk / Hear
See
Sit
Repetitive Use of Hands
COMPETENCIES
Agility
Resourcefulness: Adapts quickly to changing circumstances; cleverly navigates obstacles and constraints.
Manages Uncertainty: Comfortable when things are in flux; readily shifts approach or behavior to fit changing circumstances.
Bias to Action
Action Oriented: Propensity to act or decide and move forward with a logical approach; can decide and act without having the total picture.
Delivering Results: Strives for high levels of achievement; maintains a clear and steady focus on meeting goals, despite obstacles; is resilient when encountering setbacks.
Customer Focus
Identifying with Customers: Understanding who the external and internal customers are and what they value.
Managing Complexity
Essence: Extracts the core meaning out of complex situations; can separate the important from the noise when problem solving; hunts for the root cause of successes and failures.
Manages Conflict
Can hammer out tough agreements and settle disputes equitably. Stays positive, constructive, and respectful, even in disagreements or conflicts.
Benefits:
Comprehensive health, dental, and vision insurance
Health Savings Account with an employer contribution
Life Insurance
PTO
401(k) retirement plan with a company match
And more!
ENVIRONMENTAL/WORKING CONDITIONS: Normal busy office environment with much telephone work. Possible long hours as needed. The description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve.
*If you are viewing this role on a job board such as Indeed.com or LinkedIn, please know that pay bands are auto assigned and may not reflect the true pay band within the organization.
*No Recruiters Please
Disclaimer:
Disclaimer: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that required of the employee. Other duties, responsibilities and activities may change or be assigned at any time with or without notice.
Originally posted on Himalayas