Billing Specialist, Denials Management -Aco

This is a remote position.

About Sound:

Sound Physicians is a leading physician partner to hospitals, health plans, physician groups, and post-acute providers seeking to transform outcomes for acute episodes of care. For 20 years our high-performing and affordable care models have combined physician leadership, clinical process, technology, and analytics to consistently improve clinical and financial performance. We are pioneers in value, working together with our partners and community providers to bridge gaps in care, from hospital to home.

 Sound Physicians offers a competitive benefits package inclusive of the items below, and more:

• Medical insurance, Dental insurance, and Vision insurance
• Health care and dependent care flexible spending account
• 401(k) retirement savings plan with a company match
• Paid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policy
• Ten company-paid holidays per year

About the Role:

The Denials ManagementBilling Specialist is responsible for following payor guidelines, legislation and regulations.  They are responsible to track, trend and provide root cause analysis of denials received by payors.  The Specialist works to eliminate denials allowing the organization to realize a decrease in the volume of denied accounts and dollars.  Candidates should have experience with a minimum of one of our core service lines.

Essential Duties and Responsibilities:

• Audit denial adjustment requests from billing vendors, field operations and Sound Physician staff.
• Work closely with Regional Operations, Contracting, Coding, Compliance, Payers, Billing companies and the Denials Committee to address issues affecting appropriate reimbursement.
• Research and analyze denial trending and root cause by payer and region. Compile data on inappropriate high volume denial types and work with payors, contracting and billing companies to resolve.
• Maintain documentation and participate in external audits in order to validate compliance with Sound Physicians policies surrounding denial adjustment requests.
• Participate in Denials Management Committee meetings and provide feedback on areas requiring improvement for denials resolution.
• Review, work and trend vendor escalations.
• Review denial and payer trends for resolution
• Partner with vendor to resolve denial and unpaid claims
• Reconcile approved adjustments to ensure that they have been posted and closed in the billing system timely, ensuring aging buckets do not increase.
• Assist department leadership with ad-hoc reports, research, analysis and special projects.
• Manage time effectively to complete assignments within established time frames, optimize collections, and meet performance goals.
• Other duties as assigned

Special Knowledge, Skills and Abilities needed to perform your job: 

• Strong analytical skills necessary to collect, analyze and interpret data, resolve complex problems.
• Organizational and prioritizing skills ability required for fast-paced environment. Must be able to work independently, paying particular focus on detail.  Self-direction required for daily work.
• Interpersonal skills necessary to communicate effectively with the Administration, the Medical Staff, billing vendors and various others in a professional and courteous manner.
• Knowledge and skilled in the use of a computers and related systems and software
• Maintains current knowledge base for regulations: state, federal, and commercial payors.
• Knowledge of Alaska payers is a plus

Education and Experience:

Education

• Minimum: High school diploma or equivalent required

Experience

• Minimum:  3-5 years’ experience in medical insurance authorization, billing, patient accounts or related role required.  Experience in denial and claims resolution required.
• Advanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business related software

Other details:

• Remote WFH
• Sitting at desk working on computer for up to eight hours (with breaks)
• Moving/lifting file boxes (up to 25 lbs)

This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.