Experienced Denial Specialist

An established and growing wellness company is looking for a dynamic and professional individual to join our innovative team. The candidate will work remotely, but live near West Palm Beach. The Denial Specialist will be responsible for:

Responsibilities of the A/R Collector

• Independently review accounts and apply billing follow-up knowledge required for all insurance payors to insure proper and maximum reimbursement.
• Use multiple systems to resolve outstanding claims according to compliance guidelines.
• Prebilling/billing and follow-up activity on open insurance claims exercising revenue cycle knowledge.
• Ability to read explanation of benefits and interrupt remark and adjustment codes.
• Timely and accurately communicate with internal teams and external customers and act as a liaison with external third-party representatives to validate and correct information.
• Comprehend incoming insurance correspondence and respond appropriately.
• Identify and bring patterns/trends to leadership’s attention re: coding and compliance, contracting, claim form edits/errors and credentialing for any potential delay/denial of reimbursement.
• Obtain and maintain knowledge of insurance payer updates/changes, single case agreements and assist management with recommendations for implementation of any edits/alerts.
• Accurately enter and/or update patient/insurance information into patient accounting system
• Appeal claims to assure contracted amount is received from third party payors.
• Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and follow up efforts for each account, utilizing established guidelines.
• Proficient in major payor portals (UHC, BCBS, Cigna and Aetna)
• Understand and follow reimbursement guidelines and policies to include timely updates and communicate changes that affect reimbursement to management.
• Manage daily work queue to prioritize high dollar claim balances.
• Review & work incoming insurance and patient correspondence including refund requests.
• Send appeals when appropriate or provide the requested medical documentation.
• Ability to review medical documentation to justify medical necessity.
• Review patient balances to ensure accuracy and follow up with patients to obtain payments.
• Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
• Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
• Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
• Working remotely
• Pass background and drug testing

Education /Experience:

· Minimum 2+ years of recent physician collections experience required.

· High school diploma or GED required.

· Experience with Chiropractic and Physical therapy codes a plus

· Must communicate effectively, both verbally and in writing, with internal and external clients.

· Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.

· Knowledge or experience working with a variety of health care insurance payers is preferred.

· Intermediate computer proficiency in Microsoft Office including Excel and Outlook.

· Critical thinker and self-starter

· Continual learner that works well independently and in a team.

Position: Full-time, Remote work, live in South Florida

Job Type: 40 hours week

Salary $17 - $20 per hour

Schedule: Monday-Friday – 8am-4pm

Principals Only. Recruiters, please do not contact this job post.

Do NOT contact us with unsolicited services or offers.

CAMP SoBe Well is proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.

Drug Free Workplace

Job Type: Full-time

Pay: $17.00 - $20.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Remote

Work Location: Remote