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Specialist, Clinical Denials & Appeals

United Surgical Partners International Inc (USPI)

Specialist, Clinical Denials & Appeals

Mineola, NY
Full Time
Paid
  • Responsibilities

    Millennium Surgical Center has an immediate need for a full time Accounts Receivable Collector to join the team!

    Job Summary : Under the direction of the Business Office Manager, is responsible for covering any aspect of the business office necessary. Successful candidate will possess outstanding multi-tasking abilities, communication and teamwork as well as the ability to keep up in a fast paced working environment. The successful candidate should be able to demonstrate previous successful/positive customer service encounters or programs.

    Duties and Responsibilities:

    • Experience in Accounts Receivable (AR).
    • PIP and Workmen’s Compensation and 3rd party claims and accounts receivables as it relates to ASC/ Outpatient Services.
    • Utilize accounting software systems and ERP solutions to manage accounts receivable and billing functions.
    • Responsible for tracking and reviewing denial EOB’s
    • Responsible for following up on unpaid and denied claims on a weekly basis.
    • Responsible to review A/R reports as it relates to open charges for non-payment including but not limited to: short payments, ineligibility, inaccurate diagnosis, inaccurate coding and no authorizations on a weekly basis.
    • Responsible for communicating effectively any trends relating to failed activities/claims, claim denials, or process issues to the Collections Lead.
    • Monitor customer credit accounts and take appropriate action to collect delinquent payments.
    • Ability to manage Cash, process checks and manage cash activity to ensure accurate and timely financial transactions
    • Knowledge of Billing Functions
    • Will be responsible for reviewing claims in the electronic health record for accuracy as well as submission of claims electronically and via paper when required.
    • Will monitor electronic claims to ensure successful transmission to clearinghouse
    • Collaborate with other team members to ensure smooth financial operations
    • Possesses the ability to work in a constantly changing environment, good judgment skills, and capable of making decisions with attention to detail.
    • Special projects and other duties assigned as needed by management

    Required Skills

    • High School Diploma or equivalency.
    • 1-2 years of previous medical claims experience required.
    • Experience in government payer claim adjudication (Medicare, Medicaid, VA, Tricare) and commercial payers (BCBS, Aetna, Cigna, UHC, etc.).
    • Familiar with reading contracts and have the ability to apply those rules to an EOB and determine a follow up/resolution path.
    • Familiar with grievance and appeals process.
    • Ability to read an EOB.
    • Must be able to communicate verbally and non-verbally in a professional way.
    • Ability to use time wisely in preparing work area to meet high-paced demand.
    • Show a genuine desire to work and improve the hospital as a whole.
    • Must be able to multi-task.
    • Strong medical terminology.
    • Must demonstrate excellent phone etiquette and exceptional customer service skills.

    #LI-CT1

    Required Experience

  • Qualifications
    • High School Diploma or equivalency.
    • 1-2 years of previous medical claims experience required.
    • Experience in government payer claim adjudication (Medicare, Medicaid, VA, Tricare) and commercial payers (BCBS, Aetna, Cigna, UHC, etc.).
    • Familiar with reading contracts and have the ability to apply those rules to an EOB and determine a follow up/resolution path.
    • Familiar with grievance and appeals process.
    • Ability to read an EOB.
    • Must be able to communicate verbally and non-verbally in a professional way.
    • Ability to use time wisely in preparing work area to meet high-paced demand.
    • Show a genuine desire to work and improve the hospital as a whole.
    • Must be able to multi-task.
    • Strong medical terminology.
    • Must demonstrate excellent phone etiquette and exceptional customer service skills.

    #LI-CT1