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Overview
Reporting to the Accounts Receivable Supervisor, this role supports the operations of the CommunityCare Revenue Cycle Management (RCM) team related to the follow-up and resolution of outstanding insurance claims. The goal of the position is to follow up on, investigate, and resolve claims that have been submitted to insurance for payment, and to create detailed notes that provide insight into the current status of the individual claims.
Please note that we currently hire candidates exclusively from the following states: Applicants outside these states will not be considered for employment at this time.
- Arizona
- Connecticut
- Florida
- Georgia
- Michigan
- North Carolina
- Ohio
- Texas
Responsibilities
Essential Functions:
- Contact insurance carriers daily to follow up on/collect past due amounts on outstanding medical claims regarding denials or benefit changes.
- Maintain an accurate, up-to-date aging of assigned accounts, including AR analysis and follow-up.
- Stay educated on billing and medical policies for all payers.
- Have a working knowledge of In and Out of Network reimbursement processes/methodologies.
- Create and follow up on appeals needed to protest denials or incorrect payments.
- Review complex denials/tasks assigned by the payment posting team and resolve accordingly, including refund requests, disputes, and appeals.
- Collaborate across all RCM departments to resolve claims payment issues.
- Ensure compliance with all company policies, procedures, and organizational values.
- Work with AR Supervisor to review/resolve open accounts as assigned.
- Perform other duties as assigned.
Knowledge, Skills, and Abilities
- Excellent relationship-building and customer service skills.
- Proficiency in computer data entry, research, and information retrieval.
- Strong attention to detail, accuracy, and ability to multitask.
- Highly developed problem-solving skills.
- Professional and courteous interaction with staff, payers, patients, and families.
- Adherence to ethical standards and organizational policies.
- Prompt issue identification and reporting.
- Reliable and predictable attendance.
- Ability to manage high work volumes and organize schedules independently.
- Effective monitoring of claims processing steps.
Qualifications
Minimum Education: High School Diploma or GED
Minimum Experience:
- 3 years managing Accounts Receivable and following up with payers.
- 1 year effective communication with insurance payers and internal teams.
- 3 years working with medical terminology, ICD10, CPT, HCPCS coding, and HIPAA.
- 2 years proficiency in Excel, Microsoft Office, medical practice management software, and EMRs.
- 3 years working with commercial, government, and state insurance payers and policies.
- 3 years handling complex insurance issues, including payer assignment, EOB adjustments, and refunds.
Additional Details
- Seniority level: Not Applicable
- Employment type: Full-time
- Job function: Accounting/Auditing and Finance
- Industry: Accounting
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