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Company

Savista · 22 hours ago

AR Specialist 2 - Complex Denials

United States

Full-time

Remote

Mid Level

$21/hr - $24/hr

3+ years exp

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Responsibilities

Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers

Update patient demographics/insurance information in appropriate systems

Research/ Status unpaid or denied claims

Monitor claims for missing information, authorization, and control numbers (ICN//DCN)

Research EOBs for payments or adjustments to resolve claim

Contacts payers via phone and/or written correspondence to secure payment of claims; reconsideration and appeal submission.

Adhere to state and federal claim and appeal guidelines.

Access client systems for payment, patient, claim and data info

Follow guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems

Secure needed medical documentation required or requested by third party insurance carriers

Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure

Understand, follow, and maintain productivity and performance based role expectations

Perform other related duties as required

Qualification

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Medical collections experienceICD-10 knowledgeCPT knowledgeHCPCS knowledgeBilling claim forms knowledgeDenialsAppeals experienceThird-party billing guidelinesPayor contracts knowledgeMicrosoft Word proficiencyMicrosoft Excel proficiencyHealth information systems knowledgeDDE Medicare claim system knowledgeGovernment rulesRegulations knowledgePatient accounting systems knowledge

Required

3-5 years of medical collections, denials and appeals experience

Experience with all but not limited to the following denials and appeals- DRG downgrades, level of care, coding, medical necessity, experimental, bundling, noncovered, and no authorization.

Advanced knowledge of ICD-10, CPT, HCPCS and NCCI

Advanced knowledge of third-party billing guidelines

Advanced knowledge of billing claim forms (UB04/1500)

Advanced knowledge of payor contracts- commercial and government

Advanced working knowledge of Microsoft Word and Excel

Advanced knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)

Preferred

Advanced knowledge of one or more of the following Patient accounting systems: EPIC, Collections Management, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon

Advanced knowledge of DDE Medicare claim system

Advanced knowledge of government rules and regulations