JOB SUMMARY:
The Revenue Cycle Specialist - Denials is responsible for researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims; and interpreting various forms of explanations of benefits (EOBs) from insurance carriers
MAJOR ACCOUNTABILITIES/CRITICAL RESPONSIBILITIES:
- Understands and interprets insurance Explanations of Benefits (EOBs), knowing when and how to ensure that maximum payment has been received.
- Researches and resolves rejected, incorrectly paid, and denied claims within an established time frame.
- Researches and resolves unpaid accounts receivable and makes any corrections in medical group’s practice management system necessary to ensure maximum reimbursement for all services rendered.
- Resubmits claim forms as appropriate.
- Professionally responds to all billing-related inquiries from patients, staff, and payers in a timely manner.
- Utilizes available resources to identify reasons for payment discrepancies.
- Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
- Accurately documents patient accounts of all actions taken.
- Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.
- Educates clinic management and staff regarding changes to insurance and regulatory requirements.
- Actively participates in practice management and payer meetings.
Required Skills
Required Experience
- Associate’s degree or medical billing certification preferred. CPC preferred.
- 3+ years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.
- 3+ years of experience working with a medical office/hospital accounts receivable system.
- Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.