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Connecticut Children's · 8 hours ago

Revenue Cycle AR Specialist II - Full Time

Hartford, CT

Full-time

Onsite

Mid Level

3+ years exp

Connecticut Children's is the only health system in Connecticut that is 100% dedicated to children. The Revenue Cycle AR Specialist II is responsible for resolving insurance balances, following up with payors, and submitting appeals and reconsideration requests on rejected and denied claims.

Health CareHospitalMedical

Responsibilities

Identifies root causes of insurance denials. Remains current with core knowledge of specific payer policies, contracts and administrative bulletins

Communicates identified payer trends such as denials for specific procedure, diagnosis codes, or other identified issues

Accurately and compliantly resolves insurance balances after payment or adjudication, and correctly identifies any patient liability (i.e., contractual/payment review, etc.) and ensures accurate resolution of account to payment or payor terms

Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites

Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution; documents all activity in accordance with organization and payor policies

Coordinate appeal when claim is denied. May partner with medical care team members on complex appeals

Submits LOMN (Letter of Medical Necessity) and other drafted appeals and reconsiderations on rejected and denied claims

Sends appeals to payors and follow up to ensure payment is made

Continue to review acct and escalate as necessary if denial is not overturned

Engages the CFC, UR, Revenue integrity or coding follow-up team for any medical necessity, auth. or coding related to denials review

Sets follow-up activities based on status of the claim; ensure full and clear account documentation on account status within system

Collaborate as a part of a team on special projects by utilizing excel spreadsheets, and effectively communicate results Performs other job-related duties as assigned

Qualification

Billing experienceDenial managementAccount receivable follow upEpicCommunication skillsTeam collaboration

Required

Applicants must reside in Connecticut, Massachusetts, or New York, or willing to relocate

High School Diploma, GED, or a higher level of education that would require the completion of high school

Minimum of 3 years Billing experience required in healthcare Rev Cycle with specialization in billing, account receivable follow up and denial management, with a High School Diploma/GED

OR Minimum of 2 years direct experience with an Associate or Bachelors

Preferred

Associate's Degree in Healthcare Management, Finance, or related field

Experience with Epic

Company

Connecticut Children's

Connecticut Children’s is a leading pediatric academic medical center consistently ranked by our peers as among the best children’s hospitals in the nation.

Founded in 1996

Hartford, Connecticut, USA

1001-5000 employees