Performs day-to-day payment resolution activities within hospital and medical group partner revenue operations. This role focuses on post-billed denials, including clinical denials, and supports the Denials Resolution team in ensuring payments are received on denied accounts, identifying root causes for discrepancies, minimizing reimbursement delays, and resolving or escalating issues.
- Receives, analyzes, and appeals denials
- Reviews and resolves payment delays, variances, overpayments, and underpayments
- Processes payments according to contracts and policies
- Conducts account reviews and identifies lost charge recovery opportunities
- Investigates reimbursement issues and coordinates follow-up with clinical departments
- Collaborates with Patient Access and other stakeholders on authorization issues
- Applies payer rules, contracts, and schedules to resolve variances
- Follows up with patients and payers to ensure prompt reimbursement
- Tracks denial types, root causes, and trends
- Files appeals and reconsiderations within required timelines
- Requests write-offs, transfers, allowances, and reversals as needed
- Documents all activity in the patient accounting system
- Prepares reports on trends, outcomes, and claim activity
- Cross-trains in related functions and supports continuous improvement
Requirements & Qualifications
- High school diploma or Associate degree in Accounting, Business Administration, or related field
- 2-3 years of experience in revenue cycle medical billing, insurance follow-up, and denial management
- Experience in a hospital, clinic, insurance company, managed care organization, or similar healthcare financial setting
- Strong written and verbal communication skills
- Strong organizational, customer service, and problem-solving skills
- Attention to detail, accuracy, and time management
- Basic proficiency with Microsoft Office (Outlook, Word, PowerPoint, Excel)
- Experience using Epic
- Familiarity with CPT, ICD-10, and HCPCS coding
- Ability to work independently and meet deadlines
- Certification such as CPB or CMRS preferred
Location
Michigan, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago