Prevail RCM is a start-up revenue cycle company based in Pearland, Texas. We are in search of knowledgeable, self-motivated, and innovative healthcare professionals who are excited to help us grow an empire with limitless opportunities.

Note: If you do not complete the assessments, your application will not be reviewed.

Position Summary: The Medical Insurance Collector will be responsible for working aging receivables on out of network insurance claims and some government payers. The Medical Insurance Collector will identify low payment, root cause denial reasons, and claim rejection issues to formulate solutions for reprocessing or submitting appeals for maximized reimbursement.

Responsibilities:

• Follow up of aging insurance claims.
• Claims resubmissions or appeals for higher paid allowables.
• Negotiate payments with Third Party Administrators for maximum reimbursement of out of network claims.
• Analyze claims for underpayment or need for corrections/reprocessing.
• Appeal submission.
• Interpretation of remits/explanation of payment.
• Analyze out of network benefits and processing of claims.
• Application of ICD/CPT/HCPCS knowledge to ensure claims processed correctly.
• Payment reconciliation or review.
• Inbound calls from insurance claims, attorney offices, and sometimes patients.
• Maintain daily goal set forth by department manager.

Qualifications for this position include:

• 5 years of Hospital Medical Billing
• Medical Terminology and general knowledge of medical records
• Current knowledge of the No Surprises Act and Texas Department of Insurance
• Out of Network benefits knowledge
• Knowledge of Major Commercial Carriers/Medicare
• Typing : 45 WPM or greater
• Professional written and spoken grammar, spelling, and phone etiquette.
• Excellent communication and organization skills.
• Must be able to multi-task.
• Must be able to work high volume accurately.
• Must be able to interpret and reconcile explanation of payments, patient payments, and posting summary in GOREV.
• Waystar Experience preferred.
• Freestanding ER experience preferred.
• Microsoft Office/Adobe.

Job Type: Full-time

Pay: $19.23 - $24.04 per hour

Expected hours: 36 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday
• No weekends

Work setting:

• Office

Work Location: In person