Healthcare Accounts Receivable

Appeal and Denials Specialist

 

Job Summary: 

Responsible for performing research and confirmation of denied accounts.  You will be responsible for preparing and writing appeal letters, with supporting documentation and performing the associated follow up activities on denied accounts in order to obtain additional reimbursement for Praxis Healthcare Solutions, LLC. Clients.

 

Duties and Responsibilities (not limited to):

• Assess accounts for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests

• Validate the accuracy of the denial and capture/document the detailed CAS code reason(s) and remark codes

• Based on the detailed finding of the denial, initiate all related and supporting documentation needed for inclusion in the appeal letter

• Identify if need to include clinical team into the review and appeal process.  When needed, coordinate and work with team ensuring complete review and supporting evidence is prepared and made available for appeal letter

• Work any assigned correspondence related to assigned accounts

• Research and follow payer specific appeal guidelines for appeal submissions

• Perform other required duties in a timely, professional, and accurate manner

• Document all activity taken on an account in the patient account notes

• Conducts appropriate account activity on accounts by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online.  Continue collection activity until account is resolved

• Responsible for maintaining inventory and that daily productivity standards of assigned accounts are met

• Request additional information from patients, medical records, and others upon request from payors

• Review payer contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as neededUpdates Plan IDs and Patient/Payor demographic information; document notes to accounts

• Identify payor issues and trends and escalate issues to Management

• Ensure compliance with State and Federal Laws Regulations for Managed Care and other Third Party Payors

• Conducts collection activity on previously appealed claims by contacting government agencies, third party payers via phone, email, or online. Provides ongoing appropriate collection activity on appeals until the payer has responded to the appeal

• Perform special projects and other duties as needed

 

 KNOWLEDGE, SKILLS, ABILITIES:

• Must be able to communicate effectively and professionally with strong attention to details and problem solving both verbally and written

• Strong telephone communication skills are required 

• Ability to prioritize work and meet deadlines is required

• Knowledge of general office procedures is required

• Ability to operate common computer systems, utilize hospital collection system and business software is required

• Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Requirements

• Intermediate knowledge of hospital billing form requirements (UB-04)

• Intermediate understanding of ICD-9, HCPCS/CPT coding and medical terminology

• Intermediate Microsoft Office (Word, Excel) skills

• Advanced business letter writing skills to include correct use of grammar and punctuation

• Understanding of the revenue cycle process

• Strong interpersonal skills

• Above average analytical and critical thinking skills

• Ability to make sound decisions

• Has a full understanding of hospital collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements

• Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims

• Intermediate understanding of EOB, hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms

• Ability to be flexible and promote teamwork

   

 

Education/Experience: 

• High School Graduate minimum education requirement, prefer some college coursework or degree

•  Strong analytical skills and strong proficiency in Microsoft Office Tools  

• 3-5 years medical claims and/or acute care hospital collections experience or prior experience in similar position

 

Location:  TX-Plano

 

Job Type – Full Time Days