Underpayment Analyst, Denials - Zero Balance
New
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
- Microsoft Excel
Requirements
- High School Diploma or GED (Associates or Bachelor’s Degree preferred).
- 5+ years’ experience in healthcare billing or collections.
- 1+ years’ client-facing or customer services experience.
- Intermediate understanding of insurance payer/provider claims processing.
- Strong computer proficiency with MS Office (Word, Excel, Outlook).
- Intermediate knowledge of ICD, HCPCS/CPT coding, and medical terminology.
- Strong understanding of the revenue cycle process.
- Full understanding of hospital reimbursement and managed care contract language.
- Familiarity with HMO, PPO, IPA, and capitation terms.
- Intermediate understanding of EOB, UB04 billing forms, and HCFA 1500 forms.
- Proven ability to meet or exceed productivity targets.
Responsibilities
- Review, evaluate, appeal, and follow up on outstanding, denied, and underpaid claims using proprietary software.
- Utilize payer payment documentation and provider contract information to determine correct reimbursement.
- Review hospital contracts to identify and collect cash payments from insurance companies.
- Research and acquire medical records and supporting documentation to submit complex underpayment appeals.
- Conduct telephone follow-up with payers to facilitate resolution of outstanding receivables.
- Ensure smooth operations and improve customer satisfaction.
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