Review contracts between hospitals and insurance carriers, model claims data, and identify lost revenue
Contact responsible party for claim payment
Prepare and forward claim appeal letters with supporting documentation for denial overturn
Establish working relationships with individuals at insurance companies
Communicate with teammates and leadership to discuss and identify trends
Contact insurance companies via phone, email, and written appeal to recover dollars
Perform analysis on large data sets to identify underpayment and denial trends
Conduct research on current laws and regulations pertaining to hospital reimbursement methodology
Contribute to client decks and weekly reports to track progress of project goals and present to leadership
Strive to maintain a personal hourly rate by meeting project metrics and goals efficiently
Attend Privacy and Security Training as required by the HIPAA Awareness Program and comply with all guidelines, policies and procedures to assure sensitive or confidential information is protected in accordance with the HIPAA rules and regulations
Other duties as assigned Requirements
Detail-oriented and organized with the ability to manage time effectively and prioritize competing tasks
Excellent communication skills both written and verbal
Basic to experienced knowledge of Excel
Effective documentation skills
Strong organizational skills
Possesses analytical capabilities and financial acumen
Must have private and dedicated workspace that ensures confidentiality
Understanding of health insurance, EHR’s, EMR’s, and claims handling
Undergraduate degree or internship in a healthcare related field preferred
Healthcare operations experience preferred
Understanding of auditing and reporting tools such as SQL
Presentation skills and client relations experience a plus
3 + years of experience in Revenue Cycle or Healthcare Claims preferred Benefits
health, dental, vision and life insurance upon hire