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Form of workDescription:
Our VEI Revenue Cycle Team is seeking a contract Billing Specialist, with a focus on Appeals & Denials. This role will be an open-ended contract covering a FTE who is out on FMLA. This is our first shot to come through for the 3rd largest hospital system in the state of Indiana!
-The primary purpose of this role is to jump in and help with Denials within the Commercial lines of insurance.
The Patient Account Representative is responsible for managing all aspects of accounts receivables to ensure maximum/timely reimbursement for services performed for hospital billing and claims. The patient account role will be responsible for keeping current on all payer specific regulations and procedures and will provide written summaries of findings and recommendations. This position is customer focused with emphasis on accounts receivable management. The Patient Account Representative is required to follow established guidelines, take action to recover delinquent accounts with the payers. Place calls to the payers to collect and assist in maintaining Network A/R days. Follow up maybe performed by way of payer websites when appropriate. This position will allow the flexibility to work from home upon completion of the initial training period.
Adheres to all network and departmental procedures and policies
Complies with applicable state/federal laws and the program requirements of accreditation agencies and federal, state and government health plans
Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others
Ensures confidentiality of patient records
Follows appropriate steps to resolve denials within specified timeframe
Follows appropriate steps to resolve insurance correspondence scanned into mail queues
Follows billing and collection procedures as outlined in policies and provides payers with the appropriate and necessary information to adjudicate claim
Maintains A/R to meet Network set goals
Meets productivity standards designated by the department
Meets QA standards designated by the department
Monitors the billing and follow up holds at all sources, ensures timely resolution and is responsible for keeping assigned tasks current
Participates in monthly conference calls with specific payers
Skills:
Medical billing, Denials, Appeals, tricare, medicare, medicaid, commercial insurance
Top Skills Details:
Medical billing,Denials
Additional Skills & Qualifications:
MUST HAVE:
- 2+ years of Medical Billing expereince where they are specifically handling DENIALS with commercial payers such as Anthem, Cigna, UHG, Humana, Aetna)
- Prior experience handling claims within goverment plans (Medicare/Medicaid/Tricare/HIP Plans)
- Understanding of the reimbursement methodologically (of contracts). For example; If anthem pays $100 but we need $150, does this person have the apptitude/knowledge to know how this pays and be able to explain the pricing difference
NICE TO HAVE:
- Open to someone with government experience if they don't have commercial
-EPIC experience would be AMAZING
DISQUALIFIERS:
- No experience with Appeals & Denials
- Only experience with manual billing
Experience Level:
Intermediate Level
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The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
