Job description
Overview
Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities.
JOB SUMMARY / PURPOSE
Under direct supervision, this position is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances related to coding denials in accordance with established standards, guidelines and requirements. The incumbent conducts follow-up process activities through review of medical records and contact with providers, phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.
Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies to bring timely resolution to issues that have a potential impact on revenues.
In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.
Responsibilities
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
2. Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
3. Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal.
4. Resubmits claims with necessary information when requested through paper or electronic methods.
5. Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
6. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
7. Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
8. Assists with unusual, complex or escalated issues as necessary.
9. Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
10. Accurately documents patient accounts of all actions taken in billing system.
11. Other duties as assigned by management.
Qualifications
MINIMUM REQUIRED QUALIFICATIONS:
Pay Range
$16.26 - $22.36 /hour
REMOTE WORK OPPORTUNITY
Your time at work should be fulfilling. Rewarding. Inspiring. That’s what you’ll find when you join one of our non-profit CHI facilities across the nation. You’ll find challenging, rewarding work every day alongside people who have as much compassion as you. Join us and together we’ll create healthier, stronger communities.
JOB SUMMARY / PURPOSE
Under direct supervision, this position is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances related to coding denials in accordance with established standards, guidelines and requirements. The incumbent conducts follow-up process activities through review of medical records and contact with providers, phone calls, online processing, fax and written correspondence, leveraging work queues to organize work efficiently. Work also includes reviewing insurance remittance advices, researching denial reasons and resolving issues through well-written appeals.
Work requires proactive troubleshooting, significant attention to detail and the application of analytical/critical thinking skills to analyze denials and reimbursement methodologies to bring timely resolution to issues that have a potential impact on revenues.
In addition, the incumbent must be able to communicate effectively with payer representatives and maintain professional communication with team members in order to support denials resolution.
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. & from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
Responsibilities
ESSENTIAL KEY JOB RESPONSIBILITIES
1. Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received.
2. Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
3. Review patient medical record to compare documentation and coding; change coding based on documentation to include diagnosis codes, modifiers, place of service, etc. Communicate with provider to resolve claims that require a written appeal or second level appeal.
4. Resubmits claims with necessary information when requested through paper or electronic methods.
5. Anticipates potential areas of concern within the follow-up function; identify issues/trends and conducts staff training to address and rectify.
6. Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels.
7. Resolves work queues according to the prescribed priority and/or per the direction of management and in accordance with policies, procedures and other job aides.
8. Assists with unusual, complex or escalated issues as necessary.
9. Organizes open accounts by denial type or payer to quickly address in bulk with representatives over the phone, via spreadsheet, utilizing an on-line payer portal, etc.
10. Accurately documents patient accounts of all actions taken in billing system.
11. Other duties as assigned by management.
Qualifications
MINIMUM REQUIRED QUALIFICATIONS:
- Knowledge of health insurance, including coding.
- Ability to communicate effectively and efficiently.
- Proficient computer skills,with the ability to learn applicable internal systems.
- Ability to work collaboratively with others toward the accomplishment of shared goals.
PREFERRED QUALIFICATIONS:
- High school diploma or equivalent preferred
- Associates degree in related field
- Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology.
- Completion of ICD-10 or CPT coding course.
- 1+ years coding experience
- Insurance follow up experience
- CPC Certification
Pay Range
$16.26 - $22.36 /hour
colinoncars.com is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, colinoncars.com provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, colinoncars.com is the ideal place to find your next job.