RC Insurance Follow-up Denial Specialist I

At Optim Health, the primary customers are patients and families, with partners being physicians and team members as employees of Optim Health.

You will protect the financial standing of Optim Health by managing billing, coding verification, collection, payment, and customer service for all payer and patient accounts. Responsibilities include processing insurance claims timely, reviewing electronic claims and submission reports, resolving and resubmitting rejected claims, and collaborating with Medical Records, Coding, Revenue Integrity, Patient Access, and Patient Financial Services to resolve billing errors.

Tasks also involve processing daily error logs, aging claims, ad-hoc reports, addressing insurance company inquiries, maintaining excellent customer service, and adherence to company policies, compliance plans, and regulations.

The role requires advanced billing procedure knowledge, prioritization and multitasking skills, understanding of the revenue cycle and departmental interlinks, working knowledge of coverage and billing rules for Government and Managed Care payers, confidentiality, communication skills, and proficiency in computer applications including Word, Excel, and PowerPoint.

Preferred qualifications include one year of experience in Revenue Cycle or related areas and a high school diploma or GED.

Primary duties include working with insurance payers for proper billing on patient accounts, maintaining follow-up reports, assisting with patient concerns, producing correspondence to payers and patients, reviewing account documentation, initiating billing and collections, documenting actions taken, processing appeals and refunds, team communications, training, auditing, and adhering to HIPAA regulations.