RC Insurance Follow-up Denial Specialist I - Remote

PRIMARY CUSTOMERS, PARTNERS, AND TEAM: 

At Optim Health, our primary customers are patients and families. Our partners are physicians and our team members are all employees of Optim Health. 

GENERAL SUMMARY: 

Protects the financial standing of Optim Health by performing functions related to the billing, coding verification, collection, payment, and customer service for all payer and patient accounts. Under general supervision, is responsible for processing insurance and billing insurance in a timely manner. Reviews assigned electronic claims and submission reports. Resolves and resubmits rejected claims appropriately as necessary. Works closely with Medical Records, Coding, Revenue Integrity, Patient Access, and Patient Financial Services departments to resolve outstanding claim errors by obtaining necessary information for accurate billing. Processes daily error logs, stalled reports, aging claims, and any ah-hoc reports. Addresses claim issues from insurance companies requesting additional information and/or checking status of billings. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. Adheres to all company policies and procedures. Adheres to Optim Health Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies. 

KNOWLEDGE AND SKILLS REQUIRED: 

 Able to work with advanced billing procedures. 

 Able to prioritize and multitask based on volume of work within specific deadlines 

 Knowledge of the Revenue Cycle and the links between departments: Charge Capture, Patient Access, HIM, Coding, and Patient Financial Services. 

 Working knowledge involving coverage, payment, compliance, and basic billing rules for Government and Managed Care payers. 

 Uses discretion when discussing personnel/patient related issues that are confidential in nature. 

 Ability to give and follow written and verbal directions. 

 Working knowledge of personal computer applications and proficient in word, excel and power point applications. Self-motivator, quick thinker, communicates professionally and effectively in English, both verbally and in writing. 

 Ability to work with all departments and all levels of management. 

EDUCATION AND EXPERIENCE PREFERRED: 

 One-year of experience in Revenue Cycle Department or related areas such as registration, finance, collections, customer service, medical, or contract management

 EDUCATION AND EXPERIENCE PREFERRED: 

 High school diploma or GED 

PRINCIPAL DUTIES AND JOB RESPONSIBILITIES: 

 Works with Insurance payers to ensure proper billing takes place on all assigned patient accounts. Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report in order to expedite resolution of accounts. 

 Works follow up report daily, maintaining established goal(s), and notifies Supervisor, of issues preventing achievement of such goal(s). Follows up on daily correspondence (denials, underpayments) to appropriately work Patient accounts. Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved. Produces written correspondence to payers and patients regarding status of claim, requesting additional information, etc. 

 Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account for proper billing protocols. Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate. Sends initial or secondary bills to Insurance payers. 

 Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary. Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and/or Manager.  Remains in consistent daily communication with team members, including new process education, regarding all aspects of assigned projects. 

 Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Supervisor and/or Manager. Assist in training new staff, performs audits of work performed, and communicates progress to appropriate Supervisor. Provides continuing education of all team members on process and A/R requirements. 

 Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account