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The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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This RN manager will work closely with the billing department, healthcare providers, and insurance companies to identify and address denials, file appeals, and advocate for the reimbursement of denied claims.
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Ensure revenue integrity functions, including charge capture, denials management, unbilled claims, and maintenance of chargemaster. Follow up on denials in order to analyze claims' denials and implement correction action plans with stakeholders including department leaders and physician.
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This is a full-time position, and duties will include medical coding and billing with the primary focus on immunizations for children, adults, and international travelers; verifying insurance eligibility and submitting claims to Medicaid, Medicare, and private insurance providers utilizing a billing practice management system (eClinicalWorks); ensuring timely posting of charges and claims for maximum reimbursement; understand denials and resolve billing issues.
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Reviews and corrects all claims/charge denials and edits that are communicated via Epic, Explanation of Benefits (EOB), direct correspondence from the insurance carrier or others and uses information learned to educate PFS and office staff to reduce future denials and edits of the same nature.
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Communicates pre-authorization and disputed prior authorization approvals/denials with physicians, members, PEHP Member and Provider Services department, PEHP Clinical Management department, and the PEHP Member Claims department through mailings, inbound/outbound phone calls, and the PEHP Message Center.
Full-timeExpandApply NowActive JobUpdated 16 days ago - UpvoteDownvoteShare Job
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The Ambulance Billing Specialist will participate in weekly and monthly meetings at each site and the with the centralized business office to address front end admissions issues, outstanding AR balances, billing issues, insurance issues, and denials.
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Collections and follow up - may be split up by insurance or by site dependent upon staff qualifications and volumeCash posting and reporting (centralized or delegated to site personnel TBD)Rebilling of claims as neededSelf-Pay collections over 30 day - we may also utilize an early out agency and collections placement consistent with CommuniCare standard policyStatement processing Job Requirements:Education:High school diploma or GED required.
$15,000Full-timeExpandUpdated Today - UpvoteDownvoteShare Job
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1+ years of experience in a medical billing office, medical office setting, or insurance company to include processing claims and a working knowledge of CPT, ICD-10, and HCPC coding. Obtains insurance prior authorization for patient prescriptions, treatments, services, or procedures and re-authorization for additional units including performing any retro-authorization requests as allowed by payers; appeal prior authorization denials and help facilitate peer-to-peer reviews as needed.
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Focus areas include: Payor contracting, EDI enrollment, insurance verification and benefit coverage, claim submission, claims follow up with emphasis on timely remittance receipt and posting of payment, denials with focus on avoidance, deposits, cash application issues, and any other issues affecting accounts receivable management.
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Denials Management: Investigate and appeal denied claims to maximize reimbursement. The successful candidate will play a crucial role in ensuring accurate and timely insurance claims processing, reimbursement, and overall revenue cycle management.
$20 - $30ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS. The Appeals Specialist is responsible for appealing all insurance denials and prepare relevant reports regarding trends in denials.
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This position works closely with the Behavioral Health Senior Director, Regional Directors, Managers, and Supervisors of each site providing data, analysis and trending of billings, denials, unbilled claims, revenue management, and receivable payable reconciliation.
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Analyze billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues. Collaborates with the Business Intelligence Manager to improve system configuration, file submission, and reduction in overall denials/rejections.
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High school diploma or Associate degree in Accounting or Business Administration or related field, and a minimum of four (4) years' experience within a hospital or clinic environment, a health insurance company, managed care organization or other health care financial service setting, performing medical claims processing, financial counseling, financial clearance, accounting or customer service activities or an equivalent combination of education and experience.
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