[Hiring] Medical Coding Denials & Edits Specialist @CorroHealth

Role Description

Reporting to the Manager, AR Services, the AR Specialist is responsible for ensuring the timely collections of outstanding government or commercial healthcare insurance receivables. The AR Specialist follows up on outstanding A/R for all payers, including self-pay and resolution of denials.

Essential Duties and Responsibilities

• Interacts with insurance plans, patients, physicians, attorneys, and fellow Team Members as needed.
• Verifies or obtains patient eligibility and/or authorization for healthcare services by searching payer websites or client eligibility systems, or by conducting phone conversations with the insurance carrier or healthcare providers.
• Updates patient demographics and/or insurance information in appropriate systems.
• Conducts research and appropriately statuses unpaid or denied claims.
• Monitors claims for missing information, authorization, and control numbers (ICN/DCN).
• Researches EOBs for payments or adjustments to resolve claims.
• Contacts payers by phone or through written correspondence to secure payment of claims.
• Accesses client systems for information regarding received payments, open claims, and other data necessary to resolve claims.
• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
• Secures medical documentation as required or requested by third-party insurance carriers.
• Obtains billing guidelines and requirements by researching provider billing manuals.
• Writes appeal letters for technical appeals.
• Verifies accuracy of underpayments by researching contracts and claims data.
• Prepares claims for clinical audit processing in the event of an authorization, coding, level of care, and/or length of stay denial.

Qualifications

• 3+ years of accounts receivable experience within the healthcare revenue cycle.
• Minimum of 2 years’ experience with Medi-Cal.
• 2+ years of experience with healthcare and/or insurance billing and processing.
• Experience with professional physician and hospital facility claims.
• Ability to read and interpret an EOB.
• Knowledge and understanding of UB04 and HCFA 1500 forms.
• High School diploma.
• Proficiency with Outlook, Excel, and Word.
• Ability to communicate in a professional and clear manner.
• Strong interpersonal skills.
• Ability to work independently, with analytical and critical thinking skills.

Physical Demands

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity are required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Members must be able to lift and move material weighing up to 20 lbs. Team Members may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.