This position researches and resolves denials on insurance claims submitted for reimbursement. Insurance payor web portals and phone calls are used to research claim status and then take the necessary steps to correct any denied claims and resubmit the claims for payment within timely filing guidelines.
Review and resolve 40 accounts assigned via work lists daily as directed by management
Focus on working complex denials across multiple payers and/or regions
Note timely filing guidelines for each claim and prioritize work to ensure each claim is submitted within those requirements
Conduct account history research as required and researches the payer remittance advice
Maintain daily ERL’s in Brightree
Appeal denied claims, including researching underlying root cause, collecting required information or documents, resubmitting claims, and all appropriate follow up activities to ensure adjudication of the claim
Perform outgoing calls, corresponds with insurance companies to obtain necessary information
Working knowledge of Microsoft Office (Mail, Word, Excel) and Internet browsing.
Well organized, detailed oriented with excellent follow-through.
Ability to complete tasks within a given time frame. Fosters a sense of urgency and follow through to resolve outstanding issues in a timely manner.
Works well with others regardless of their level or background; is respectful; maintains positive relationships even under stressful or difficult circumstances; deals with different points of view or disagreements in a constructive, successful manner.
Ability to function well while involved in multiple task assignments and in a fast-paced environment.
Anticipates and prepares for short and long-term challenges/trends; sees how his/her work relates to others as well as the organization as a whole; understands implications of decisions; translates ideas and concepts into practical applications.
Language: Intermediate ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence.
College graduate or equivalent, preferably RN but not required
Medical terminology and medical insurance industry experience preferred
Experience with Brightree software preferred
Familiarity with home medical equipment and related supplies preferred
Knowledge of major insurance carrier reimbursement guidelines and coverage (preferred)
While performing the duties of this job, the employee is occasionally exposed to the following conditions: work near moving mechanical parts. The noise level in the work environment is usually moderate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job the employee is regularly required to sit, talk, hear and use hands. The employee is occasionally required to stand, walk, reach with hands and arms, stoop, kneel, crouch, crawl, taste/ smell, and lift/move (up to 25 lbs). Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Questions? Contact email@example.com