This position is responsible to resolve aged accounts and must have denial management experience in multiple states and sometimes internationally. Must have Revenue Cycle Management experience. Professional communication skills are required for interaction with colleagues, payors and management. Experience working in the ambulance transportation field preferred.
• Denial Management – Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
• Trend Identification – Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
• Payor Escalation – Ability to understand and navigate payor guidelines. Determine and escalate claim issues with payor when appropriate.
• Trend Escalation – Meet with leadership to discuss/resolve reimbursement and/or payor obstacles.
• Appeals – Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier. Take appropriate action to resolve claim.
• Claim Status – Use available resources such as payor portals and clearinghouses to review unresolved accounts.
• Unapplied Payments – Identify unapplied payments and take appropriate action to resolve account.
• Phone Calls - Call appropriate payors or patient to obtain the information necessary to resolve the claim.
• Medical Record Requests – Obtain necessary information from appropriate source(s) to obtain payment from payors. This includes obtaining records from treating facilities.
• Medical Insurance Policies - Knowledge and understanding of current policies and procedures required to determine claim resolution.
• Overpayment Resolution – Process or appeal refund requests following federal, state and/or payor guidelines.
• Legal/Subrogation Requests – Knowledge of HIPAA and multiple state guidelines to process attorney requests.
• Coordination of Benefits – Ability to review eligibility response and determine payor sequence. Knowledge of Medicare Part A vs Part B benefits and liability guidelines.
• Patient Inquiries - Respond to written and verbal inquiries from patients regarding their account. Process charity and payment plan following established policy.
• Communication – Clear and concise communication both written and verbal, including documenting all activities associated with an account.
• Production and Quality Standards – Must meet company standards and ability to work in fast paced environment.
• Other responsibilities as assigned
• Prefer minimum 3 years in medical reimbursement field
• Ability to read and understand EOBs
• MS Excel skills (filtering and formatting reports)
• MS Word skills (formatting of letters and templates)
• PDF (formatting and editing in Adobe Acrobat or equivalent)
• Position requires HS or GED equivalent and some college level courses
• Ability to speak confidently to insurance representatives and patients
• Experience in billing 1500 and UB04 claim forms
• Understanding of non-contracted and contracted payer behaviors
• Ability to interact professionally on all levels
• Type 45 wpm, 10-key by touch
• Knowledge of medical terms.
• Ability to operate office equipment.
• Candidate must be able to provide documentation to support ability to work in the United States within the federal legal guidelines.
Compensation and Benefits:
Golden Hour Data Systems offers a very competitive salary as well as an excellent benefits package. Benefits include health insurance, dental, life, eye insurance, AD&D, LTD, and we participate in the benefit premiums. In addition, we offer Flexible Spending, 401k matching, 15 days a year PTO, 9 paid holidays.
Golden Hour appreciates and values diversity! We are an equal opportunity employer and do not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, gender identity, genetic information, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.