Reviews and analyzes denials and short payments from insurance plans to determine the best resolution strategy. Takes action to obtain payment in accordance with payor contract terms, applicable billing guidelines, and federal and state laws.
Interacts with clinical team members as needed to gather pertinent clinical facts supporting medical necessity of services provided. Tracks payment requests to ensure timely follow-up, reconciles business system and reports, and prepares formal appeal documents.
Reviews managed care balances related to short payments, denials, and aged accounts with no response. Evaluates authorization, coding, billing, and correspondence to identify root causes and determine the best collection approach. Compiles detailed written appeal documents outlining the position for payment.
Maintains production and quality standards, reports payment and denial trends to management, and creates spreadsheets of open accounts. Works with payor contacts to exchange data, identify root causes, and confirm resolution.
High school diploma or equivalent required.
Two years of experience in a hospital or physician business office, managed care collections, or managed care claims environment required.
Requires critical thinking and effective communication skills, with the ability to make independent decisions.
Requires detailed knowledge of government and managed care insurance terminology and reimbursement methodologies.
Requires knowledge of federal and state regulations and laws/statutes related to payment for medical services.
Requires knowledge of proper billing and coding of hospital services.
Must be able to formulate and write formal business communications.
Intermediate knowledge of Microsoft Word and Excel required.
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 week ago