Position Highlights:

Responsible for the coordination and management of timely insurance claim follow-up including identifying, monitoring, appealing, and resolving denied claims.  Perform detailed analysis on denied claims with a focus on maximizing revenue.

T The Ideal Candidate:

• In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines.
• Computer literate, knowledge of financial data analysis, intermediate Excel skills.
• Preferred – Physician claims experience in a multi-specialty environment, preferably with oncology and/or surgical experience.

Responsibilities:

• Follow-up electronically and/or telephonically with payors for claim and appeal status.    
• Make a preliminary determination whether denial can be overturned and if initial or secondary appeals should be submitted.
• Research and prepare responses for payor requests for additional information and documentation.
• Review of non-clinical denials including identification of root cause.
• Resolve non-clinical denials which include researching and reviewing payor guidelines, writing and submitting appeals with supporting documentation if required.  
• Other duties as assigned.

Credentials and Qualifications:

·    Associate degree required.

·   Minimum of three (3) years experience working with medical claims in a hospital, physician, payor or third party medical billing service setting with collection experience.

•      * "in lieu of" Associate's a H.S. Diploma with two (2) years of additional related claims/collection experience may be considered.      
•      **"in lieu of" the three (3) years medical experience five (5) years collection experience in a non-medical setting will be considered.     

Successful experience in tracking claims, drafting appeals, overturning denied claims.
   • For HMO/PPO/Commercial Collectors, experience with non-government payors preferred, including eligibility           inquiries, billing and claim submission experience. 
   • For Government Collectors, experience with Medicare and/or Government payors preferred, including eligibility inquiries, billing and claim submission experience. 
   • For Medicaid/Medicaid HMO Collectors, experience with Medicaid/Medicaid HMO payors preferred, including eligibility inquiries, billing and claim submission experience.
 
Computer literate, knowledge of financial data analysis, intermediate Excel skills.
In depth knowledge of Medicare and Medicaid regulations, third party reimbursement guidelines.
Excellent communication skills both written and verbal.