Job Description

In this role, the successful candidate performs advanced level work related to resolution of physician claim denials. This position will be responsible for root cause analysis physician payer denials, experience in identifying procedures impacted by National Correct Coding Initiative Edits (NCCI), technical payer policies, appeal documentation and resolution.

In addition, this position will be responsible for identification, collaboration, and implementation of process initiatives to reduce denials.

Highlights

• Exceptional problem solving and critical thinking skills to root cause denials and resolve accounts. Must meet quality and productivity standards.
• Demonstrates knowledge and expertise in state / federal billing guidelines, reimbursement methodologies, and payer policies.
• Makes recommendations for additions / revisions / deletions to work queues and claim edits to improve efficiency to reduce denials and underpayments.
• Identifies patterns and escalates to management as appropriate with sufficient information for additional follow up, and or root cause resolution.
• Exceptional Excel skills to summarize and provide detailed reporting to management and client.
• Tracks and trends claim denials and underpayments to identify initiatives for payer, process, or technology improvement plans.
• Strong communication skills both verbal and written to ensure all actions taken are documented, appeal letters are effective and root cause is communicated.

Preferred

• 2-3 years’ experience working in healthcare revenue cycle.
• Associates or Bachelors preferred or equivalent experience in denial management.
• Documented technical skills, Excel, Payer Portals, and Claims Clearinghouses.

The Accounts Receivable Specialist role responsibilities include following up directly with payers to resolve claim issues and secure appropriate and timely reimbursement.

Identify and analyze denials and payment variances and take action to resolve account including drafting and submitting technical appeals.

Other Job Duties Include

• Examine denied and underpaid claims to determine the reason for discrepancies.
• Communicate directly with payers to follow up on outstanding claims, file technical appeals, resolve payment variances, and ensure timely reimbursement.
• Ability to identify with specific reason underpayments, denials, and cause of payment delay.
• Works with management to identify, trend, and address the root causes of issues in the A / R.
• Maintain a thorough understanding of federal and state regulations, as well as payer-specific requirements and take appropriate action accordingly.
• Document activity accurately including contact names, addresses, phone numbers, and other pertinent information.
• Demonstrate initiative and resourcefulness by making recommendations and communicating trends and issues to management.
• Needs to be a strong problem solver and critical thinker to resolve accounts. Must meet productivity and quality standards.

The hourly rate for this position is between $18.00 20.00 per hour, depending on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant’s discretionary annual incentive program,based on performance and subject to the terms of Cognizant’s applicable plans.

Benefits : Cognizant offers the following benefitsfor this position, subject to applicable eligibility requirements :

• Medical / Dental / Vision / Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term / Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Disclaimer : The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.

Education and / or Experience Associates degree or equivalent from two-year College or technical school or six months to one-year related experience and / or training or equivalent combination of education and experience.

Cognizant will only consider applicants for this position who are legally authorized to work in the United States without requiring company sponsorship now or at any time in the future.

An inclusive environment embracing diversity : for the second time, Cognizant has been named to the Forbes list of Best Employers for Diversity based on survey responses from its employees!

Shift : Day Job

Job Posting : Apr 30 2024

Last updated : 2024-05-01