Medical Insurance Recovery Specialist/Follow-Up

Insurance Recovery Specialist

Essential Job Functions

·         Investigates insurance denials to identify action necessary – using calls to payor and multiple computer systems, e.g. Epic, insurance portal, clearing house, etc.

·         Able to analyze EOBs at a claim level

·         Corrects claims based on denials and rebills using payor approved processes

·         Determines need for payor appeal of a claim and sends appeals via payor portal or payor appropriate appeal letters. Monitors appeals for resolution

·         Adjusts accounts appropriately, using correct denial codes

·         Recognizes when additional assistance is needed to resolve denials and escalates appropriately

·         Spots trends and reports them to management

·         Works a minimum of 45 accounts per day with 97% accuracy

·         Communicates effectively both verbally and in writing

·         Documents all activities and findings in accordance with established policies and procedures.

·         Performs special projects or other duties as assigned

·         Maintains strictest confidentiality, adhering to all employer and government privacy standards, e.g. 42 CFR part 2 and HIPAA

·         Maintains current knowledge of internal, industry and government regulations as applicable to denial management

Experience REQUIRED:

·         High school graduate or equivalent

·         2 years previous experience in medical revenue cycle

·         Familiarity with Excel

·         Demonstrated problem solving ability

·         Able to work in office or hybrid schedule

·         Strong organizational skills

Experience Preferred:

·         2 years previous experience in medical denial management

·         Minimum 1 year recent Epic experience with the Resolute/Billing module

·         Knowledge and experience in working with health care insurance portals

·         A good understanding of CPT, modifiers, HCPC, ICD-10 and medical terminology

·         Working knowledge of Medicare, Medicaid and Commercial payor fee schedules and reimbursement documentation, e.g. payor rules, non-payable codes, etc.

·         Basic computer knowledge (saving and locating files in OneDrive, Outlook, excel)

Skills:

·         Ability to effectively prioritize and execute tasks

·         Ability to make decisions based on available information and within scope of their authority

·         Have excellent customer service skills and telephone interaction skills

·         Excellent keyboarding skills, typing and 10 key

·         Proficiency with MS Word and Excel