Job Description

Join a team of dynamic, results oriented professionals!

Named among The World’s Most Admired Companies" by Fortune Magazine

Named among "America's 100 Most Trustworthy Companies" by Forbes magazine

Named among Great Places to Work" by Becker’s Hospital Review

• Career Growth Opportunities
• Convenience market on site
• Benefit Eligibility (Medical / Dental / Vision / Life) the first of the month following 30 days of employment
• 401K program (Discretionary matching funds available)
• Employee Assistance Program
• Referral Program
• Dental plans & Vision plans
• GENEROUS Personal time off
• Eight Paid Holidays per year
• Quarterly incentive plans
• Business casual dress code
• Free Parking
• Free coffee daily
• Employee of the month awards with monetary gift and parking space
• Training Programs
• Fitness Center with personal trainer on site
• Awesome Facility with terrific amenities
• Wellness programs
• Flexible work schedule

JOB DESCRIPTION OVERVIEW :

This position is responsible for reviewing carrier denials from Medicaid, Medicare, Blue Cross Blue Shield, Managed Care, and Commercial Insurances.

Maintains accuracy and production to ensure remittances are being processed effectively and appeals are resolved through payment.

ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Reviews EOB's and enters rejection codes, comments, and rebills claim as necessary.
• Reviews denials to determine appropriate action based on carrier requirements.
• Contacts Medicare, Medicaid, Managed Care, Commercial, and Blue Cross Blue Shield to inquire on claims.
• Assembles and forwards appropriate documentation to the senior representative for provider related issues and claim spec issues.
• Reviews Medicaid, Medicare, Managed Care, and Blue Cross Blue Shield provider manuals and updates.
• Reports any consistent errors found during review that affect claims from being processed correctly.
• Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager.

Last updated : 2024-05-08