SUMMARY:

The Insurance Denial & Appeals Clerk is responsible for maintaining current patient accounts. Handles insurance claim denials, rejections and resubmission of claims. The position reviews third party payer reimbursement denials based on the following: documentation, billing accuracy, medical necessity, coding, modifier and related issues. Uses data from these reviews to identify and rectify billing and documentation errors, maintain and communicate denial / appeal activity to appropriate staff and report suspected or emerging trends related to payer denials to Billing Manager.

QUALIFICATIONS

High school graduate or equivalent 2 years' experience preferred in managing insurance appeals and denials Extensive knowledge of third party billing and payment methodologies required Knowledge of CPT, ICD-10-CM, HCPCS, and modifiers necessary Excellent computer skills including Excel, Word, and Internet use Detail oriented with above average organizational skills Plans and prioritizes to meet deadlines Good oral and written communication skills Ability to deal professionally, courteously and efficiently with the public and all levels of the organization Ability to handle multiple projects simultaneously Ability to operate computer, copier, fax Proficient in practice management system and Microsoft Office software applications Knowledge of HIPAA guidelines and requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement. Receives denied claims and researches appropriate appeal steps. Communicates directly with the payer, resubmits denied claims, underpaid claims and claims that are inaccurately processed. Tracks and documents all denials by payer, visit type and denial category. Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials. Works with the payers to understand specific reasons for denials and preventable measures available to prohibit future denials. Process patient refunds in a timely manner, submitting refund requests at the time of insurance payment/EOB receipt. Communicate with multiple levels in the organization (e.g, managers, physicians, clinical and support staff). Maintain confidentiality of sensitive information Work closely with the billing manager and billing staff to identify and resolve any denials issues related to provider credentialing. Work special projects set by billing manager. Other duties as assigned. Cross trained to provide billing department coverage in any task needed to meet end of the month deadlines. Responsible for staying current with the rules and updates or changes in state and federal regulations. Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.

Pay:

From $17.00 per hour

Benefits:

401(k) matching Employee assistance program Health insurance Life insurance Paid time off

Work Location:

In person