Job Summary:

Creates and manages submission, intervention and resolution of bills, appeals, and grievances both electronically and manually Conducts pertinent research, evaluates, responds and completes appeals and other insurance/policy guideline inquiries accurately, timely and in accordance with all established regulatory guidelines. Prepares appeal documentation, summaries, correspondence, as well as documents information for tracking/trending data. Review denied insurance claims, identify and resolve the issues in order to resubmit. Develop strategies to reverse claim denials. Manage and organize appeal workflow based on internal and insurance-driven deadlines. Researches insurance policy language to determine medical necessity criteria. Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research. Collaborates with other team members to determine appropriate responses. Prepare documentation for submitting bills/grievances/appeals. Maintains current knowledge of regulatory billing requirements. Monitors and tracks the number of appealed claims. Assure timeliness and appropriateness of all appeals according to state, federal, and company guidelines, but not limited to.

Required experience:

Prior experience in the creation, submission, and completion of all hospital bills and insurance appeals. Knowledge of Medicare and Medicaid rules and regulations. Office administrative experience and the ability to work independently while effectively researching and maintaining the most current government laws and patterns of insurance denial, etc. Computer literacy, especially with

MS Office Desired Skills:

Efficient multi-tasking. Strong organizational skills Ability to prioritize workload based on strict deadlines. Attention to detail. Effective organization of work assignments. Effective written and oral communication. Ability to self-motivate and learn quickly. Ability to review and understand insurance policy language and guidelines. Understand and comply with HIPAA regulations. Familiarity with Commercial Insurance, Medicaid and Medicare claims denials and appeals processing, and knowledge of NCCI guidelines and LCD/NCD Edits for appeals and denials. Ability to accept change in work assignments as needed. Performs other duties as assigned. This position will serve our clients in the Northeast. Familiarity with the Tri State Area Payers and Fiscal intermediary necessary

Job Type:

Full-time Pay:

From $55,000.00 per year

Benefits:

401(k) 401(k) matching Dental insurance Flexible schedule Health insurance Life insurance Paid time off Vision insurance Application Question(s): Have you read the job description in its entirety and meet all requirements?

Education:

Bachelor's (Preferred) Ability to

Commute:

Garden City, NY 11530 (Required)

Work Location:

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