Medical Claims Research Representative (Remote) In Remote At Teamhealth

Job Description

TeamHealth is named among the “150 Great Places to Work in Healthcare” by Becker’s Hospital Review and has ranked three years running as “The World’s Most Admired Companies” by FORTUNE Magazine as well as one of America’s 100 Must Trustworthy Companies by Forbes Magazine in past years. TeamHealth, an established healthcare organizations is physician-led and patient-focused. We continue to grow across the U.S. from our Clinicians to our Corporate Employees and we want you to join us.

• Career Growth Opportunities
• Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
• 401K program (Discretionary matching funds available)
• GENEROUS Personal time off
• Eight Paid Holidays per year
• Quarterly incentive plans

*This is a remote-based, work-from-home position*

JOB DESCRIPTION OVERVIEW:

This position is responsible for reviewing claims rejected due to a provider or claims issues. Maintains accuracy and production to ensure invoices are being processed efficiently.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

• Reviews ETM task list assignment, comments, and processing specific provider-related denials
• Reviews denials to determine appropriate action based on carrier requirements
• Identifies and reports provider termination/enrollment issues per policy guidelines
• Identifies and reports carrier-specific claim issues per policy guidelines
• Assembles and forwards appropriate documentation to the senior representative for provider and carrier-related issues
• Reviews carrier provider manuals for billing updates as needed and reports these updates to the Senior/Supervisor
• Reports any consistent errors found during the review that affect claims from being processed correctly
• Participates in department meetings with the Accounts Receivable Team
• Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
• Performs all duties as directed by Supervisor, and Accounts Receivable Manager

Job Requirements

QUALIFICATIONS / EXPERIENCE:

• Thorough knowledge of revenue cycle
• Thorough knowledge of healthcare reimbursement guidelines
• Computer literate, intermediate knowledge of Excel
• Able to work in a fast-paced environment
• Good organizational and analytical skill
• Ability to work independently
• High school diploma or equivalent
• One to three years’ experience in physician medical billing with emphasis on research and claim denials
• General knowledge of ICD and CPT coding