DENIAL/APPEALS SPEC-ABQ PAC Full-Time
Location: Albuquerque, New Mexico
Description: Presbyterian Healthcare Services is employing DENIAL/APPEALS SPEC-ABQ PAC Full-Time right now, this job will be delegated in New Mexico. For complete informations about this job opportunity kindly see the descriptions. Minimum Skills/Requirements
High school degree or GED required, short-term training on insurance collections and claims processing. Minimum two years! experience in
insurance follow-up, billing and collections. One year of similar medical facility, physician’s office or experience with a major carrier in claims processing preferred. Demonstrated ability to communicate effectively via telephone and in writing. Computer literate. Must be able to work closely with co-workers.
Requires detailed knowledge of insurance filing and healthcare billing systems and processes. Solid understanding of ICD9, CPT coding, UB92
and 1500 form locator requirements. Understanding of DRG, APC and managed care reimbursement methodology
Thorough knowledge of various payer contracts, to include managedcare and commercial insurance payers. Responsible for familiarizing self
with reimbursement rates, filing limits and other contract specific guidelines that pertain to determining accuracy of third party payments
and appealing denied claims.
Primary Job Functions
- Performs accounts receivable! reimbursement analysis and denial management activities for t! heir assigned payers/accounts using monthly aged account work queues and/or A/R reports.
- Responsible for identifying and documenting insurance payer issues as they arise. Must communicate all issues to teammates and supervisor. Responsible for maintaining files containing all pertinent information for each account to include correspondence, EOB’s, claims, letters of appeal, medical records etc.
- Must be an effective team member with good communication skills. Must participate in team meetings, communicate work related ideas and concerns proactively, and assist in finding appropriate resolutions.
- Responsible for contacting insurance companies, patients, and employers regarding outstanding claims. Responsible for providing any information (medical records, itemized statements, etc.) required by insurance companies to overturn denied claims. Must maintain a system to ensure timely follow-up is completed for each outstanding account.
- Maintai! n status reports consisting of outstanding accounts assigned. Must work and document the report according to Patient Accounting Department policies and procedures. Responsible for following up on all accounts listed on the report until resolved.
- Refer accounts, in accordance with PHS guidelines, to Follow-up & Collection Manager for write-off, or agency or attorney referral. Refer difficult accounts to Supervisor or Manager for advice and/or assistance.
- Must work closely with all outside agencies contracted with the Patient Accounting Department and assist them with account resolution for any accounts assigned to them by the Follow-up & Collection supervisor/manager.
- Cross train in the various Patient Accounting Department areas to be completely familiar with all aspects of Patient Accounting functions as they relate to collections.
- Ensures that all job functions are performed within the established quality and quantity standards. Adheres! to all PHS and Patient Accounting Department policies and procedures t! o promote a smooth working environment and uphold the PHS vision by practicing the CARES behaviors at all times.
- Performs other duties as assigned.
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If you were eligible to this job, please deliver us your resume, with salary requirements and a resume to Presbyterian Healthcare Services.
Interested on this job, just click on the Apply button, you will be redirected to the official website
This job will be started on: Sat, 01 Jun 2013 01:46:54 GMT
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