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Customer service, including resolving account disputes, processing credit memos, reviewing and completing lien releases, following up on returned checks or credit card denials, etc. Customer service, including resolving account disputes, processing credit memos, reviewing and completing lien releases, following up on returned checks or credit card denials, etc.
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Responsible for contacting the SLPG practice or Network Prior Authorization Department to obtain required insurance referrals and pre-certs when not previously documented in chart prior to service to decrease denials for no authorization.
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Monitors reimbursement trends (e.g., HCPs receiving notification of policy changes, claim denials, underpayments, etc.) Reimbursement experience with physician-administered injectables and/or medical devices, Category III CPT codes and/or miscellaneous J-codes, specialty pharmacy and buy & bill acquisition, and benefit verifications, prior authorizations, claims assistance, and appeals.
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Prepares reports on investigation, settlements, denials of claims and evaluations of involved parties, etc. Informs insureds and claimants of claim denials when applicable. With operations in 54 countries, Chubb provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients.
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Makes the necessary recommendations regarding billing and edit creation to reduce denials. Identifies payor specific patterns or trends regarding denials and reports to management for communication to Medical Departments and Administrators.
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Follow up on unpaid, denied, or under/overpaid claims, working closely with payers to determine reasons for denials and taking corrective actions. You will research claim denials, identify root causes, and collaborate with departmental leadership to prevent future denials.
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Revenue Cycle to include Charge Capture, Collections, A/P, Denials Management. Surgical service lines include General Surgery, Vascular, Orthopedics, Spine, Podiatry, Urology, ENT, Pain Management, Plastics, Gynecology, and GI. The hospital also has 2 Catheterization Labs in which 600 coronary and peripheral intervention cases are performed annually.
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2+ years Collections and Denials experience, Experience working in a high volume setting (80+ claims per day), Excel experience, Comprehensive knowledge of ICD-10 coding, CPT coding, HCPCS coding, modifiers, and government and commercial payer guidelines., Experience working from home (no distractions.
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Provides immediate, on-going education of healthcare team members on such issues as payer requirements, denials, avoidable delays/variances, regulatory agency regulations, compliance, post-acute provider referral processes and other appropriate alternative care options.
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Appropriately works the accounts receivable and denials using the collection tool and policies and procedures to achieve department and hospital goals. Responsible for the timely follow-up on accounts and resolves denials and/or correspondence.
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Some knowledge of physician denials and appeals experience preferred. Identifies denials and underpayments for appeal. Updates account information and documents as appropriate within Epic Resolute.
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Review denials; Resubmitting appropriately as checked by the pharmacist. Review denials; Resubmitting appropriately as checked by the pharmacist. Produce and check reports Print daily controlled substances (DEA) report; Daily transaction report to count number of patients served each day and check for all prices; Print Medicaid for audits with corrections and claims submissions printout.
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Managing Medicare Medical Review and Denials process in conjunction with Director of Rehabilitation, the facility team, and therapy staff. Managing Medicare Medical Review and Denials process in conjunction with Director of Rehabilitation, the facility team, and therapy staff.
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Works collaboratively with the Denials Specialist and Physician Advisors to manage retrospective appeals and documents according to established policy. The Utilization Review Nurse will be responsible for substantiating medical necessity and clinical appropriateness of services in order to achieve quality outcomes and ensure appropriate reimbursement.
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The Documentation Integrity department is comprised of coding, clinical documentation improvement, and denials professionals who work together daily to ensure the most optimal and accurate picture is presented for the patients and communities we serve via the diagnosis and procedural coding, appropriate patient admission status and denial appeal processing, when necessary.
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