Variety Care · 1 month ago
Lead, Claims Resolution (66922)
Oklahoma City, OK
Full-time
Onsite
Mid, Senior Level
3+ years expVariety Care is a healthcare organization focused on providing quality care to patients. The Claims Resolution Lead is responsible for resolving unpaid insurance claims by researching denials, managing the collection process, and ensuring compliance with billing regulations. This role also involves leveraging technology to identify process inefficiencies and recommending improvements to enhance revenue flow.
Health CareMedicalNon Profit
Responsibilities
Monitors the clearinghouse to resolve issues and errors in a timely manner
Evaluates and works A/R balances to promote timely filing and prevent loss of revenue from denials and missed opportunities on secondary filings
Identifies claim denial reasons, eligibility discrepancies and billing errors, and resolve them in a timely fashion to ensure prompt payment of claims
Makes inquiries and follows up on all denied and unpaid insurance claims to include Medicare, Medicaid, and third-party insurances
Processes requests for denied claims information using website portals and outbound phone calls for all payers
Resolves edits related to coding, obtains and reviews required documentation to support services billed
Researches and locates missing payments and/or remittance advice forms
Reviews and obtains appropriate documentation for claim re-submission per insurance guidelines and requirements
Contacts patients and/or referrals for missing information or documentation
Tracks and maintains follow-up documentation of claim re-submissions
Documents all communication with co-workers, patients, and payer sources in patient’s account in electronic health record
Oversees insurance correspondences, researches, and performs appropriate steps for first and second appeals
Works with insurance payors to ensure timely and accurate payments
Communicates with insurance carriers to track status of appeals
Tracks improvement of targeted denials once processed, or when system edits have been developed to reduce/prevent future denials
Troubleshoots patient account issues including direct resolution of billing issue with patients. Ensures accurate patient statements are sent out monthly along with analyzing patients accounts and makes recommendations to collections accordingly
Tracks and reports ongoing issues and trends to the Manager of Revenue Cycle Management
Meets established daily, weekly, monthly, and annual deadlines
Manages and maintains relationships with all payors to improve patient revenue
Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information
Follow written and verbal instructions from the Manager of Revenue Cycle Management
Exhibits professionalism in communication with patients, clients, insurance companies, and co-workers
Participates in special projects
Support Variety Care’s accreditation as a Patient-Centered Medical Home and our commitment to provide care to all Variety patients that is Safe, Effective, Patient-Centered, Timely, Efficient, and Equitable. Provide leadership and work with all staff to achieve the goals of the “Triple Aim” of healthcare reform—to improve the experience of care, improve health outcomes, and decrease healthcare costs
Embodies the strength of personal character. Places value on being an open and honest communicator who displays high moral and ethical conduct, integrity, adaptability, and sound judgment. Must be a leader in the department and community. Result-oriented problem solver who is responsible and accountable
Performs other duties as assigned
Qualification
Required
High School Diploma or GED
Three years medical billing experience
Prior experience with medical billing and insurance collections or healthcare revenue cycle experience including diversified experience with payers, managed care contracts, and payer methodology
Expert knowledge of CPT codes
Proficient knowledge of medical terminology and protocols as well as basic knowledge of coding and anatomy
Experience with critical thinking, analytics, problem-solving and sound decision-making
Experience interacting and communicating effectively with individuals at various levels both inside and outside the organization, often in sensitive situations
Proficient knowledge of Microsoft Office and practice management software systems
Professionalism, integrity, responsibility and dependability
Experience with detail, negotiation, and problem-solving skills
Preferred
Associates degree or equivalent combination of experience and education
Company
Variety Care
Variety Care provides healthcare services.
501-1000 employees
Funding
Current Stage
Late StageLeadership Team
Allen Tinsley
CIO
Recent News
The Journal Record
2022-11-24
Company data provided by crunchbase