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We are looking for a Revenue Cycle/Medical Collections Associate to be responsible for focusing on collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers. This is a remote position and will report to the Manager of Reimbursement Operations. The ideal candidate must be able to: (1) Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage. (2) Be persuasive and persistent when following up on claims status, and (3) process an appeal, resubmit/rebill, or forward claims for adjudication as necessary.
Job Responsibility:
Verify claim was submitted to correct insurance
Review/update patient demographics and information for accuracy
Process and validate payor requests and claims via correspondence, remittance advice and EOBs (i.e., identify payment discrepancies, inappropriate requests)
Investigate all denied services to determine reason and appeal, if appropriate
Identify and report root causes associated with denials to reduce/resolve issues
Process assigned appeals including submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)
Maximize utilization of Billing system, tools and resources to support cash collection activities
Review various reports including aging outstanding and denial reports
Comply with Federal and State legislation on all billing related matters
Comply with all Safety, Emergency, Hazard, OSHA, HIPAA, Quality Assurance and Administrative Plans, Policies, Guidelines, Protocol, and Standards
Support and maintain department cash and DSO goals
Requirements:
Minimum of 4+ years specializing in Medical Collections at a diagnostics company, laboratory or other healthcare provider, doing collections from commercial payers
Hands-on experience handling the entire appeals process
Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal, State, & PPO, HMO, and Indemnity Plans structures
Working knowledge of appropriate coding systems
CPT, ICD-10 and HCPCS, coverage
LCD/NCD and reimbursement associated with such codes
High School Diploma or a Bachelor’s degree from a four-year college or university
Strong problem solving skills with ability to streamline and improve processes, use good judgment, attention to detail and follow-through are a must
Excellent customer service skills
excellent verbal and written communication skills
Excellent troubleshooting and time management skills, attention to detail, utilizes time in constructive manner
Ability to easily adapt to increased business demands
Ability to effectively work with and resolve complex accounts & billing issues
Self-starter, ability to work independently and be self-motivated to overachieve goals
Ability to effectively prioritize and multi-task
Ability to work in fast paced environment, perform under pressure, meet tight timelines
Establish and maintain cohesive and good working relationships
What we offer:
Working alongside brilliant, kind, passionate and dedicated colleagues, in an empowering environment, toward a global vision, striving for a future in which transformative molecular diagnostics can help millions of patients
Open, transparent culture that includes weekly Town Hall meetings
The ability to indirectly or directly change the lives of hundreds of thousands patients
Multiple medical benefit options
employee premiums paid 100% of select plans, dependents covered up to 80%
Extremely generous Family Bonding Leave for new parents (16 weeks, paid at 100%)
Supplemental fertility benefits coverage
Retirement savings program including a 4% Company match
Increase paid time off with increased tenure
Latest and greatest hardware (laptop, lab equipment, facilities)
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