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SalaryWe are looking to build our AR Denials and Appeals team. This is a work from home position. If you have experience working with insurance, processing claims and enjoy working independently this may be an opportunity for you.
Experience Essential: Two years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.
Must communicate clearly and professionally, in both written and verbal manners with internal personnel, payors, providers, patients, and other authorized representatives in regards to outstanding balances.
Must have a working phone and internet service to use for work. Company provides work at home computer kit.
Pay Range: $15.45-$18 /hour + a competitive benefits package
Education Essential: High School or Equivalent
This position is a work from home role with onsite training.
Location: 210 Office Building, US:FL:Lakeland
Position Summary
Responsible for collecting payments for outstanding hospital claims, managing accounts, researching denials, submitting corrected claim requests, submitting appeals, and ensuring payments received are reconciled correctly with emphasis place on HIPAA compliance and in accordance with departmental goals, SOP’s, and contract terms.
Position Details
Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites.- Collect payments for outstanding claims and ensure payments received are reconciled correctly.
- Utilizes contract management system to obtain the claim expected reimbursement information to ensure claims are paid correctly. Follows department’s process for follow up on underpayments/overpayments.
- Research and prepare responses for payor requests for additional information or documentation.
- Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
- Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial.
- Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines.
- Responsible for adequately working correspondence timely and efficiently (including EOBs, RA’s, denial letters).
- Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry.
- Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary.
- Identify complex and aged claims issues and follows internal escalation process appropriately.
- Maintain patient confidentiality and privacy; adheres to HIPAA standards.
- Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.
- Must meet department Productivity Guidelines. Works with all areas of the department to assure maximum productivity. Utilizes the PFS Productivity tracker.
- Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
- Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.
