This position serves as Adirondack Health’s primary contact for patient and insurance reimbursement issues in accordance with established policies and payer requirements. The role is responsible for managing and resolving insurance claim denials, with a focus on surgical and high-dollar accounts, including claims with unlisted procedure codes.
The position supports the revenue cycle’s financial integrity by analyzing denial trends, coordinating appeals, collaborating with internal teams, improving first-pass resolution rates, and reducing recurring denials. All communication must support positive patient relations and prompt reimbursement for services.
Must have a high school diploma; a bachelor’s degree in business or a related field, or an equivalent combination of education and experience, is preferred.
Required experience includes at least 3 years in PFS directly involved in billing and collections of accounts receivable. At least 3 years in a lead capacity is preferred.
Candidates must have proficiency with third-party payers, patient accounts and billing, payer rules, coding guidelines, and appeal processes. Strong understanding of explanation of benefits (EOBs) is required.
Additional qualifications include:
- Proficiency using computer terminals and personal computer equipment
- Strong reporting background and advanced Microsoft Excel skills
- Excellent interpersonal, analytical, and problem-solving skills
- Ability to communicate effectively with patients and insurance companies
- Professionalism, flexibility, and comfort working with employees at various levels
Full-time employees are eligible for:
- Medical, dental, and vision insurance
- Paid benefit time, including PTO and sick days
- Tuition reimbursement
- 403(b) retirement plan with employer contributions
- Additional company benefits
Location
New York, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago