Description

Who We Are:

As the only independent and physician-led faculty practice plan of the University of Tennessee Health

Science Center, University Clinical Health (UCH) offers best-in-class clinical care through a network of

175 providers across 19 specialties to meet the healthcare needs of the Mid-South community. UCH is a not-for-profit, non-tax-supported group practice and is here to serve the community while providing medical excellence to our patients.

Position Summary:

This position is responsible for claim resolution of all assigned denial types. This position is responsible for identifying and escalating denial trends to the Accounts Receivable Supervisor. This position should include the ability to recognize and communicate with insurance payers for additional review, reconsideration, or appeals.

Key Results Areas (KRAs):

· Conduct AR Follow-up on denials through best practices. Launch appeals, as needed, via the UCH practice management system.

· Demonstrate a detailed understanding of how to read and interpret EOBs and denials from all insurance carriers (including the financial components such as co-pays, deductibles, and co-insurance).

· Possess a thorough knowledge of claim resolution from end to end across all payer categories based on insurance denials.

· Differentiate between best practices of appeal, coding review, credentialing review, and/or adjustment.

· Contact insurance companies and utilize web portals and websites for appeal, eligibility, remittance, and payment information.

· Candidate must be able to report and communicate issues and trends.

· Meet or exceed daily productivity benchmarks.

· Other assigned duties/tasks.

Core Competencies

· Complete understanding of follow-up processes.

· Solid background in Accounts Receivable and overall Revenue Cycle policies and procedures.

· Experience working in a physician billing environment.

· Excellent communication skills.

· Excellent systems experience and acuity. (EMR and Billing and Collection Systems). Multi-system and multi-specialty experience is preferred.

· Proficiency in Microsoft Office Suite, including Word and Excel. 

· Ability to communicate orally and in writing clearly and straightforwardly.

· Ability to communicate effectively with senior leadership and company personnel.

· Ability to make decisions and solve problems while working under pressure.

· Ability to prioritize and organize effectively.

· Ability to show judgment and initiative and to accomplish job duties.

· Ability to work independently.

· Strong business acumen.

· Strong communication skills including public speaking.

Requirements

Education & Experience:

• High school diploma or equivalent required
• 3 years of experience in claims resolution or medical billing
• Formal certification in medical billing and coding or have equivalent experience 
• Working knowledge of CPT, ICD-10, and medical terminology

EOE-University Clinical Health provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, genetic information, or any other characteristic protected by federal, state, or local laws. University Clinical Health is a VEVRAA Federal Contractor – priority referral Protected Veterans requested.