Job Summary :

Job Description

Essential Responsibilities:

• Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement.
• Examines denied and underpaid claims to determine reasons for discrepancies.
• Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers.
• Uses highly effective language to write appeals and resolve denials.
• Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing AR.
• Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies.
• Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information; thoroughly documents all interactions with payers.
• Effectively handles all communications from payers and departments within HRH.
• Utilizes EPIC work queues, dashboards, and reports to identify high-risk accounts and prioritizes follow up efforts.
• Participates in continuous quality improvement efforts in process and system optimization.
• Demonstrates initiative and resourcefulness by making recommendations based on current trends.
• Understands and maintains compliance with HIPAA guidelines when handling patient information.
• Performs other duties as assigned.

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the associate for this job. Duties, responsibilities and activities may change at any time with or without notice.

Education and Experience Required:

• Must be a high school graduate or equivalent.
• Medical certification in Healthcare/Revenue Cycle preferred.
• Minimum of one to three years experience considered; three or more years of experience preferred.

Work Shift :

Scheduled Weekly Hours :