Revenue Cycle Associate Claims & Denials

DUTIES & RESPONSIBILITIES:

• Apply in-depth knowledge of medical claims denial and insurance follow-up to independently review accounts and take action for proper adjudication and payment.
• Manage incoming correspondence from payors and respond timely to ensure claims are processed and resolved efficiently.
• Prepare and submit payor appeals with supporting documentation; utilize external payor portals for claims management follow-up and appeal submission.
• Contact insurance payors via phone or electronic means to obtain claim status updates and pursue resolution.
• Interpret claim edits rejections and coverage guidelines to identify appropriate solutions and minimize delays in reimbursement.
• Accurately update patient accounting systems with correct demographic and insurance data documenting all actions taken on accounts.
• Analyze denial trends identify root causes and assess the impact on accounts receivable; recommend or initiate corrective action as needed.
• Manage assigned work queues efficiently to meet established productivity and quality standards preventing timely filing denials.
• Maintain up-to-date knowledge of Medicare Medicaid Medicare Advantage Managed Care and Commercial insurance billing practices including fee schedules and consolidated billing.
• Apply understanding of ambulance medical billing documentation requirements (e.g. PCS forms transfer of care certification levels) and compliance with federal and state coding guidelines.
• Write and file detailed appeals with insurance carriers using clinical coverage policies and payer-specific documentation requirements.
• Review insurance claim forms remittances and correspondence to ensure accurate payment and resolve claim denials.
• Demonstrate strong analytical and critical thinking skills to apply payer-specific coverage policies effectively.
• Stay current on ambulance coding regulatory billing guidelines and changes in insurance laws and reimbursement policies.
• Maintain confidentiality and comply with all HIPAA and privacy standards federal and state regulations and the agencys compliance program.
• Collaborate cross-functionally and continuously seek ways to improve workflow customer service and internal operations.
• Provide quality customer service to patients including verifying insurance responding to inquiries resolving account issues and ensuring timely follow-up.
• Proficiently use billing software clearinghouses and relevant tools for electronic claim submission and account management.
• Demonstrate flexibility by supporting other revenue cycle functions when needed such as registration coding cash posting and payment posting.
• Maintain positive working relationships with internal departments external payors and the general public

EDUCATION/EXPERIENCE:

• Experience in the healthcare revenue cycle process
• Experience working insurance denials and appeals
• Familiarity with payer portals and clearinghouses
• Excellent verbal communication skills
• Demonstrated ability in the use of Microsoft products
• Ability to perceive and distinguish emotions during interactions with people via telephone and respond courteously
• Maintain acceptable attendance and adhere to scheduled work hours
• Ability to work within a team-oriented fast-paced customer focused environment
• HS diploma/GED required; Associate degree preferred

CERTIFICATIONS/LICENSES/REGISTRATIONS:

• Certified Ambulance Coder (initial certification only) preferred

Individuals must not be excluded from filing claims to any federal or state government payor.

SALARY RANGE:

Starting pay $23.23/hr; additional based on experience.

Interested applicants must complete the online application and upload a resume to be considered for the position. Applications will be accepted until the position is filled.

If you have any further questions please contact MEDIC Recruitment at

Required Experience:

IC