Medical Insurance Claims Lead

The Revenue Cycle Lead, reporting to the Revenue Cycle Manager, acts as a subject matter expert for all revenue cycle functions and activities. This position is responsible for ensuring compliance with third party payor requirements as well as all applicable state/federal laws and regulations.

Only candidates able to commute to the jobs on-site location (Northbrook, IL) Monday through Friday 5 days a week will be considered. Remote work is not an option.

Responsibilities

• Acts as subject matter expert for assigned revenue cycle areas, ensuring optimal revenue collection and patient satisfaction with the billing experience and ensuring compliance
• Performs RCA (Root Cause Analysis) to resolve problems affecting the revenue cycle and develop solutions to implement.
• Contacts insurance regarding claim status, denials, underpayments, and recoupments
• Read and understand insurance eligibility and benefits
• Research & resolve outstanding claim issues and patterns
• Submit Appeals for Denied Claims
• Submit Medical Records and other documentation requests to insurance
• Ability to work on 50+ denied claims per day on the phone and provider portals
• Ensures compliance with USAVC policies and procedures, health plan requirements, and federal and state laws and regulations
• Additional duties as assigned

Requirements

• Bachelor's Degree plus 3 or more year's previous experience in medical collections, or an equivalent of experience and education, required
• Minimum of 2 years prior revenue cycle experience required
• Experience with Aetna, BCBS, UHC, Medicare, and Medicaid denials required
• Experience with multi state insurance denial collecting a preferred
• Familiar with provider portal eligibility and claim tools. Example: Availity, Navinet required
• Ability to read and understand insurance remittance including denial and remark codes required
• Ability to understand the remittance denial codes and get claims reprocessed required
• Strong personality and willingness to rebuttal with Insurance Claims representatives to overturn denials
• Exceptional customer service and phone etiquette
• Thorough understanding of physician billing practices and procedures, including knowledge of state, local and federal laws
• Strong knowledge of reimbursement rules and methodologies for both physician and ambulatory surgery billing
• Strong knowledge of Microsoft Excel (VLOOKUP and Pivot Tables)

Benefits

• Health
• Dental
• Vision
• 401K & match