Complex Denials HB Accounts Receivable 2

Overview

This role involves supporting healthcare organizations by managing medical insurance accounts receivable to ensure timely collection of outstanding government or commercial healthcare insurance payments. The position focuses on improving financial outcomes through effective revenue cycle management.

Responsibilities

• Verify and obtain eligibility and authorizations using payer websites, client systems, or direct communication with insurance carriers
• Update patient demographics and insurance information in relevant systems
• Research and monitor unpaid or denied claims
• Check claims for missing information, authorizations, and control numbers (ICN/DCN)
• Analyze Explanation of Benefits (EOBs) for payments or adjustments to resolve claims
• Contact payers via phone or written correspondence to secure payment, submit reconsiderations, and appeals
• Access client systems for payment, patient, claim, and data information
• Follow prioritization guidelines, timely filing deadlines, and notation protocols within systems
• Obtain necessary medical documentation requested by third-party insurance carriers
• Maintain confidentiality of patient information according to insurance collection guidelines and corporate policies
• Perform other related duties as required
• Familiarity with hospital billing complex accounts receivable workflows

Requirements

• 2-3 years of experience in medical collections, complex denials, and appeals
• Experience handling denials such as DRG downgrades, level of care, coding, and medical necessity
• Intermediate knowledge of ICD-10, CPT, HCPCS, and NCCI coding systems
• Intermediate understanding of third-party billing guidelines
• Intermediate knowledge of billing claim forms (UB04/1500)
• Intermediate knowledge of commercial and government payor contracts
• Intermediate proficiency with Microsoft Word and Excel
• Intermediate knowledge of health information systems (e.g., EMR, claim scrubbers, patient accounting systems)

Preferred Qualifications

• Intermediate knowledge of one or more patient accounting systems such as EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
• Intermediate knowledge of the DDE Medicare claim system
• Intermediate understanding of government rules and regulations related to healthcare billing

Compensation & Benefits

• Salary range: $20.00 to $23.00 per hour
• Actual compensation will vary based on geographic location, experience, certifications, and skills

Equal Opportunity Statement

The employer is an Equal Opportunity Employer and does not discriminate based on race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity, or any other protected class under federal, state, or local law.