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.

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.

Responsibilities

Essential Functions :
• Contact insurance carriers on a daily basis 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.
• Keep 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 reviewing refund requests, disputes and appeal as necessary.
• Work across all RCM departments to get issues related to claims payment resolved.
• Uphold and ensure compliance and attention to all company policies and procedures as well as the overall mission and values of the organization.
• Work with AR Supervisor to review / resolve open accounts as assigned.
• Perform other duties as assigned.

Knowledge, Skills and Abilities :
• High level of skill at building relationships and providing excellent customer service.
• Ability to utilize computers for data entry, research and information retrieval.
• Strong attention to detail and accuracy and multitasking.
• Must have highly developed problem-solving skills.
• Executes excellent customer service and professionalism when interacting with staff, payers, patients and families to ensure all are treated with kindness and respect.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations, organizational policy, and accreditation / compliance requirements.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.
• Acts in accordance with CommunityCare's mission and values, while serving as a role model for ethical behavior
• Manage high volumes of work and organize / maintain a schedule independently.
• Must be able to effectively monitor steps in claims processing operations.

Qualifications

Minimum Education :

High School Diploma or GED

Minimum Experience :
• 3 years of experience managing Accounts Receivable and performing direct follow up with payers.
• 3 years working with medical terminology, ICD10, CPT, HCPCs coding and HIPAA requirements.
• 2 years of experience with data processing and analytical skills, proficiency in Excel and Microsoft Office Suite as well as medical practice management software and electronic medical records.
• 3 years of experience working with commercial, government and state insurance payers and their reimbursement policies and procedures.
• 3 years' experience working complex insurance issues, including assigning correct payer, EOB adjustments and refunds to accounts.

Last updated : 2024-09-17