Resolution Analyst, Denials
United States - RemoteFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years’ experience in healthcare field working in billing or collections
- Required Skills
- MS Office
Requirements
- High School Diploma or GED required; Associates or Bachelor’s Degree preferred.
- 5+ years’ experience in healthcare field working in billing or collections.
- 1+ years’ client facing/customer services experience.
- Intermediate understanding of insurance payer/provider claims processing and data requirements.
- Strong computer proficiency with MS Office (Word, Excel, Outlook).
- Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
- Strong understanding of the revenue cycle process.
- Full understanding of hospital reimbursement.
- Intermediate knowledge of Managed Care contracts, Contract Language, and Federal/State requirements.
- Familiarity with HMO, PPO, IPA, and capitation terms.
- Intermediate understanding of EOB, UB04 billing forms, and HCFA 1500 forms.
Responsibilities
- Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims using proprietary software and tools.
- Use payment documentation and medical provider contract information to determine correct reimbursement.
- Identify and collect cash payments from insurance companies by reviewing hospital contracts.
- Research, request, and acquire medical records and supporting documentation to submit complex underpayment appeals.
- Conduct timely telephone follow-up with payers to facilitate resolution of outstanding receivables.
- Ensure smooth operations and improve customer satisfaction.
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