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Appeals and denials management. The Medical Collections Specialist will be tasked with following up with insurance rendered regarding denials and rejections. The Medical Collections Specialist must be well versed with Medi-Cal, HMO, PPO and Government insurance.
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Review remittance reports for denials, errors and resubmits claims with correct data. Works all denials manually and/or electronically by using the designated systems on a timely basis, report problems to Supervisor/Manager.
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Assess each account for balance accuracy, payer plan and financial class accuracy, billing accuracy, denials, insurance requests, making any necessary adjustments, documenting appropriately and submits corrections or request for processing in a timely manner.
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Knowledge of PPO, HMO, EPO, diagnostic codes, CPT codes, and Medicare/Medicare part D plans. Reviews insurance denials and submit appeals as permitted by payor. Knowledge of PPO, HMO, EPO, diagnostic codes, CPT codes, and Medicare/Medicare part D plans.
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Person MUST come with 1 year of experience and knowledge in Veteran Affairs, Worker Compensation, Medicaid, Medicare Advantage, PPO and Prior Authorization Appeals are all a MUST. Nature of Work: Person will be doing Verification of Benefits in the Appeals process for prior authorization/denials/exceptions, etc.
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Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections. Knowledge of insurance guidelines including HMO/PPO, Medicare, Medicaid, and commercial payers.
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Person MUST come with 1 year of experience and knowledge in Veteran Affairs, Worker Compensation, Medicaid, Medicare Advantage, PPO and Prior Authorization Appeals. Person will be doing Verification of Benefits in the Appeals process for prior authorization / denials / exceptions, etc.
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Problem-solving skills to research and resolve discrepancies, denials, appeals, collections. Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid. Knowledge of HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
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In-depth knowledge of Medicare, Medicaid, PPO, HMO, and other third-party billing requirements. Possess in-depth knowledge of Medicare, Medicaid, PPO, HMO, and other third-party billing requirements.
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Directly address all insurance denials received. PPO - more phone base and less access to Insurance portals. Opportunity for Hybrid (1 week in office; 1 week remote) after 9-12 months (Determined by Performance and Attendance.
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Collaborate with Provider Relations Manager, Verification of Benefits Manager and Revenue Cycle manager on payment analysis and providing feedback for new patient admissions and or continuation of care.
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Stewarding the end of life journey well requires an unwavering clinical skill set balanced by the art of compassion. Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
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Payment posting, Health care, cash postings, payment poster, HMO, PPO, ERA, EOB, health insurance, reconciliation, health insurance claims, revenue cycle. Accurately post payments, adjustments, and denials in the billing system.
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Follow up on unpaid claims within standard billing cycle timeframe. Review patient bills for accuracy and completeness and obtain any missing information. Minimum of 1 to 3 years of experience in a medical office setting.
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Resolve claim processing issues in a timely manner, evaluating problem claims to the appropriate managerial personnel with the insurance carrier's organization to quickly resolve delinquent claims or contacting patient or third party payers in compliance with established policies and procedures.
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