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Patient Account Insurance Denials and Follow-Up Specialist Full-Time

Company: Rogers Behavioral Health
Location: Oconomowoc
Posted on: May 6, 2021

Job Description:

The Patient Account Insurance Denials and Follow-Up Specialist is responsible for following up directly with commercial and governmental payers to resolve billing issues and secure appropriate reimbursement in a timely manner. This individual identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors. -- -- -- Principle Duties and Responsibilities-- --

  • Examines denied and underpaid claims to determine reasons for discrepancies
  • Communicates directly with payers to follow up on outstanding claims, resolve payment variances, and achieve timely reimbursement
  • Provides payers with specific reasons for suspected underpayments and analyzes denial reasons given by payers
  • Works with management to identify, trend, and address root causes of denials; helps pinpoint strategies for reducing A/R
  • Maintains a thorough understanding of federal and state regulations, as well as specific payer requirements and explanations of benefits, in order to identify and report billing compliance issues and payer discrepancies
  • Updates and maintains accurate files on each payer, including contact names, addresses, phone numbers, and other pertinent information; thoroughly documents all interactions with payers
  • Effectively handles all communications, including telephone and email, from payers and departments within the organization as it relates to billing
  • Utilizes payer scorecards, identifies high-risk accounts, and prioritizes follow-up efforts
  • Participates in continuous quality improvement efforts on an ongoing basis, establishing goals with supervisors and tracking progress
  • Demonstrates initiative and resourcefulness by making recommendations and communicating trends and issues to management
  • Understands and maintains compliance with HIPAA guidelines when handling patient information
  • Performs other duties as assigned -- -- -- Benefits:---- --
    Comprehensive benefits package (medical, dental, vision, etc.) for positions of 30 hours or more per week.---- Childcare reimbursement offered for positions of 20 hours or more per week.------ Gainshare bonus based on company goals.---- 401k with matching contribution that is fully vested from day 1.-- Loan relief, tuition reimbursement and scholarship opportunities.-- -- -- -- ABOUT ROGERS BEHAVIORAL HEALTH---- ---- Rogers Behavioral Health is a nationally recognized, not-for-profit provider of highly specialized psychiatric care. Rogers offers evidence-based treatment for children, teens, and adults with OCD and anxiety, addiction, depression and other mood disorders, eating disorders, trauma, and PTSD. Backed by more than a century of experience, Rogers is leading the way on measurement-based care and use of clinical outcomes.------ ---- Rogers provides residential care and has three inpatient facilities located in southeastern Wisconsin. Rogers also offers outpatient services in a growing network of communities across the U.S.---- ---- The System also includes--, which supports patient care, programs, and research; and--, an initiative that works to eliminate the stigma of mental health challenges. For more information, visit--.-- ------ ---- To apply, please visit and complete an online application.-- -- EOE/MFDV--Required Skills
    • Knowledge of claims review and analysis, along with understanding of healthcare explanation of benefits (EOB)
    • Effective communication, organizational, and strong problem-solving skills
    • Function with a great deal of autonomy
    • Ability to manage multiple tasks and projects simultaneously
    • Adapts positively to changes in the working setting with ease
    • Strong interpersonal and customer service skills, coachable
    • Basic computer skills
    • Working knowledge with Microsoft Suites: Word, Excel, OneNote, Teams, Outlook
    • Verbal and hearing ability required to interact with patients and employees. Strong numerical ability required to maintain records and operate a computer.
    • Must be able to read and communicate through written, verbal, and auditory skills and abilities.
    • Physically/Mentally able to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical. Sedentary (seated) position Required Experience
      • High school diploma or equivalent required
      • One to three years of relevant experience in medical or mental health collections or professional billing preferred
      • Knowledge of all payer's insurance, self-pay after insurance, reimbursements, collections, appeals, claims follow-up and third-party billing, required
      • Experience with medical records or patient accounting systems.
      • Knowledge and understanding of state and federal insurance program to ensure compliance and accurate reimbursement, required.
      • Knowledge and understanding of healthcare explanation of benefits (EOBs) forms.
      • Electronic medical record software experience, preferably Cerner.

Keywords: Rogers Behavioral Health, Milwaukee , Patient Account Insurance Denials and Follow-Up Specialist Full-Time, Other , Oconomowoc, Wisconsin

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