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This contract-to-permanent position involves managing the full insurance revenue lifecycle, ensuring accurate claim submissions, resolving denials, and maintaining compliance with payor contracts and regulations. The role also includes provider credentialing and re-credentialing responsibilities, as well as collaborating across departments to enhance operational efficiency.
Job Responsibility:
Oversee insurance accounts receivable processes from initial charge posting to final resolution
Investigate and resolve unpaid, underpaid, or denied claims promptly and accurately
Ensure claims meet payor guidelines and adhere to clean-claim standards to prevent revenue loss
Post payments and adjustments with precision and reconcile explanation of benefits to maintain accuracy
Monitor credentialing timelines for providers, ensuring timely enrollment and re-credentialing with contracted payors
Identify and address root causes of claim denials, implementing corrective measures to mitigate recurring issues
Maintain compliance with state regulations, payor contracts, and internal revenue integrity standards
Track and report key revenue cycle metrics, such as denial rates, days in accounts receivable, and net collection ratios
Collaborate with operations leadership and care center teams to resolve reimbursement issues and streamline processes
Serve as the primary liaison for credentialing matters, audits, and compliance reviews related to provider enrollment
Requirements:
Minimum of 3 years of experience in healthcare, dental, or medical insurance accounts receivable and revenue cycle management
Proficiency in handling accounts receivable, cash applications, and billing functions
Solid understanding of health care revenue cycle processes, including collections and cash activity
Strong analytical skills to identify issues and implement solutions for claim denials and payment discrepancies
Familiarity with payor-specific regulations and contractual requirements
Ability to manage provider credentialing and enrollment processes efficiently
Excellent communication and collaboration skills to work effectively across teams and departments
Strong attention to detail and organizational skills to maintain compliance and ensure accuracy in all tasks
What we offer:
medical, vision, dental, and life and disability insurance