Mambo Seafood Restaurants · 1 day ago
AR / Denials Specialist
Southern Pines, NC
Full-time
Onsite
Mid Level
3+ years expSummit Spine and Joint Centers is a rapidly expanding Pain Management Group looking to add an experienced Accounts Receivable / Denials Specialist to their team. The role involves maximizing collections, processing insurance denials and appeals, and managing outstanding accounts to ensure timely resolution and payment.
Food & Beverages
Responsibilities
Processes assigned AR, working to maximize collections while minimizing aging AR
Process insurance denials and appeals to ensure timely account resolution
Identify denial trends and provide management with a summary of identified issues
Manages outstanding accounts to include following up with insurance carriers for overpayments, underpayments, filing corrected claims, appealing claims, and following up on all denials to ensure processing / reprocessing and timely payments
Review AR aging to ensure timely collection of payments
Review and initiate payor and patient refunds
Appropriately documents issues, sources, and actions taken on each account
Identify, document, and report payer denial trends to billing manager for escalated follow-up
Creates reports regarding the status of patient accounts as requested
Address inquiries from insurance companies, patients, and providers
Ensure claim information is complete and accurate
Post office paper zero pay denials, and scan into our system
Verify patient benefits and eligibility
Maintain denials productivity spreadsheet
Follows HIPAA guidelines in handling patient information
Qualification
Required
Minimum of 3 years' experience with accounts receivable or revenue cycle in a medical setting
Experience with Medicare, Medicaid, Commercial insurance plans, Workers' comp, and Personal Injury cases
Knowledge of claims submission of office visits, outpatient procedures, urinary drug screens, DME, MRI, and Chronic Care Management
Knowledge of medical billing rules, such as coordination of benefits, modifiers, and understanding of EOBs and ANSI code denials
Excellent knowledge of CPT coding, ICD.10 coding and medical pre-certification protocols required
Excellent computer skills and familiarity with Microsoft Office
Comfortable working in a growing, dynamic organization and able to navigate change
Self-motivated with ability to multi-task, prioritize work in a fast-paced, team environment
Preferred
Bachelor's degree preferred
Experience using eClinicalWorks preferred
Experience with Pain Management preferred
Benefits
PTO
Health benefits
401k match
Company
Mambo Seafood Restaurants
Mambo Management is the parent company of Mambo Seafood Restaurants.
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Nuno Lima
Chief Executive Officer
Tim Leong
CFO
Company data provided by crunchbase