Responsibilities:

-Reviews, researches, appeals, and resolves denials for all payors and service areas at all types of denials (medical necessity, coding, bundling, coordination of benefits, frequency, limited coverage, etc.)

-Perform appropriate follow up actions for daily claim denials, including submitting corrected claims, calling the insurance payer to investigate and resolve.

-Provides clinical argument using available medical records to justify, appeal, and dispute payer denials.

-Works with billers, coders, and providers to appeal denials.

-Maintain workflow to keep aging accounts at a minimum by timely follow up on unpaid/underpaid/denied claims.

-Review and work incoming insurance correspondence, including refund requests.

-Identify and report denial trends from payers that affect timely reimbursement.

-Research and resolve customer inquiries/issues.

-Assist with meeting monthly close deadlines with billing and accounts payable.

-Perform regular audits on patient accounts to ensure accurate insurance and patient balances.

Qualifications:

-Strong medical billing knowledge with a minimum two years’ experience in medical billing and AR follow up.

-Ability to read and interpret insurance explanation of benefits and cash application methods.

-Ability to edit and resubmit claims for payment.

-Proficient in use of payer websites/portals.

-Highly organized and detail oriented.

-Understanding of medical terminology, insurances payers and lines of business.

-HCPC/ICD-10 codes, medical billing practices, and billing reimbursement.

-Vascular surgery experience is a plus.

-Experience with Trizetto is preferred.

Job Types: Full-time, Part-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Clinic
• Medical office

Experience:

• ICD-10: 1 year (Required)
• Denial Management: 2 years (Required)

Work Location: In person