Medical Billing Reimbursement Specialist-6

Locations: Remote, MD, United States of America; Placeholder, TN, United States of America; Remote, FL, United States of America; Remote, GA, United States of America; Remote, CO, United States of America; Placeholder, MN, United States of America; Remote, AZ, United States of America; Placeholder, UT, United States of America; Placeholder, NV, United States of America; Remote, IL, United States of America; Placeholder, OH, United States of America; Remote, PA, United States of America; Remote, OR, United States of America; Remote, TX, United States of America; Placeholder, IN, United States of America; Placeholder, ID, United States of America; Placeholder, AL, United States of America; Placeholder, OK, United States of America; Remote, KY, United States of America; Placeholder, MS, United States of America

Data Management

This position is responsible to resolve aged accounts and must have denial management experience in multiple states and sometimes internationally. Must have Revenue Cycle Management experience. Professional communication skills are required for interaction with colleagues, payors and management. Experience working in the ambulance transportation field preferred.

Responsibilities

• Coordination of Benefits – Ability to review eligibility response and determine payor sequence. Knowledge of Medicare Part A vs Part B benefits and liability guidelines.
• Overpayment Resolution – Process or appeal refund requests following federal, state and/or payor guidelines.
• Phone Calls - Call appropriate payors or patient to obtain the information necessary to resolve the claim.
• Denial Management – Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
• Medical Insurance Policies - Knowledge and understanding of current policies and procedures required to determine claim resolution.
• Trend Identification – Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
• Other responsibilities as assigned
• Medical Record Requests – Obtain necessary information from appropriate source(s) to obtain payment from payors. This includes obtaining records from treating facilities.
• Payor Escalation – Ability to understand and navigate payor guidelines. Determine and escalate claim issues with payor when appropriate.
• Communication – Clear and concise communication both written and verbal, including documenting all activities associated with an account.
• Unapplied Payments – Identify unapplied payments and take appropriate action to resolve account.
• Claim Status – Use available resources such as payor portals and clearinghouses to review unresolved accounts.
• Appeals – Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier. Take appropriate action to resolve claim.
• Production and Quality Standards – Must meet company standards and ability to work in fast paced environment.
• Legal/Subrogation Requests – Knowledge of HIPAA and multiple state guidelines to process attorney requests.
• Trend Escalation – Meet with leadership to discuss/resolve reimbursement and/or payor obstacles.
• Patient Inquiries - Respond to written and verbal inquiries from patients regarding their account. Process charity and payment plan following established policy.

Qualifications

• MS Word skills (formatting of letters and templates)
• Ability to operate office equipment.
• Ability to speak confidently to insurance representatives and patients
• Type 45 wpm, 10-key by touch
• Ability to read and understand EOBs
• Understanding of non-contracted and contracted payer behaviors
• PDF (formatting and editing in Adobe Acrobat or equivalent)
• Candidate must be able to provide documentation to support ability to work in the United States within the federal legal guidelines.
• Prefer minimum 3 years in medical reimbursement field
• MS Excel skills (filtering and formatting reports)
• Knowledge of medical terms.
• Position requires HS or GED equivalent and some college level courses
• Ability to interact professionally on all levels
• Experience in billing 1500 and UB04 claim forms

Golden Hour appreciates and values diversity. We are an equal opportunity employer and do not discriminate in hiring or employment on the basis of race, color, religion, national origin, citizenship, gender, gender identity, genetic information, marital status, sexual orientation, age, disability, veteran status, or any other characteristic protected by federal, state, or local law.