At SCP Health, what you do matters

As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.

Why you will love working here:

- Strong track record of providing excellent work/life balance.

- Comprehensive benefits package and competitive compensation.

- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.

Job Responsibilities:

• Review (AR (Accounts Receivable)) by payer daily to maintain or achieve reimbursement goals and days in AR.
• Prepare timely appeals to overturn medical necessity, and various denials.
• Provide regular feedback to management based on payer research and behavior trends.
• Weekly feedback on payer/facility adjudication concerns.
• Improve reimbursement outcomes and resolve outstanding claims inventory.
• Identify the root cause of the non-payment and resolve the claim denial issue, including coding and billing errors, documentation issues and compliance discrepancies.
• Maintain high productivity and quality of work.
• Achieve a minimum score of 95% on all Quality Assurance audits.
• Develop and execute effective appeals strategies to overturn denied claims.
• Prepare and submit detailed and well-documented appeals to insurance companies within specified deadlines.
• Possess knowledge of medical coding specific to professional emergency room and hospital medicine services.
• Collaborate with coding specialists to address and rectify coding-related denial issues.

•  Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services.
•  Collaborate with the medical billing team to address root causes of denials and implement preventive measures. Provide training to billing staff on denial prevention and resolution. 
• Meet production standards.

Knowledge, Skills, and Abilities:

• Understanding of the overall revenue cycle process through final account adjudication.
• Excellent written and oral communication skills.
• Strong interpersonal skills.
• Meticulous and organized.
• Ability to work effectively in a team environment.
• Professional attitude and demeanor.
• Initiative-taking and problem-solving skills.

Education (Required and/or Preferred):

• High School or Equivalent Required: Proven experience in denial management, specifically in professional emergency room and hospital medicine service.

Work Experience/Qualifications:

• 2+ years of experience in Medical Insurance Denials Management.
• 2+ years of experience in customer service and patient billing within the medical industry.
• Experience reading Explanation of Benefits (EOB’s) for Government, Commercial, PPO, HMO/IPA, and Workers’ Compensation payers.
• Ability to review and validate credits to be refunded and validate recoupment demands.
• Intermediate ability to assess and verify patient liability, coinsurance, deductibles, and denial codes.
• I have an intermediate knowledge of MS Office.
• Knowledge of ICD-9, ICD-10, CPT, HCPCS coding, and general claims processing practices.
• 10-key by touch, Proficient in MS Excel, and Word.
• Previous patient medical billing, OnBase, Centricity, and Way Star, Payor Portals experience a plus.

Certificates and Licenses:

None required.

Work Environment and Physical Demands:

• Professional setting.
• Continuous sitting.
• Continuous computer use.
• Occasional bending, kneeling, lifting, pulling, and pushing up to ten pounds.
• Elevated level of mental awareness.

Primary Location:

• Dallas, Texas

Confidentiality:

The daily activities of this position require strict confidentiality regarding individuals and strategic initiatives. Confidentiality must be maintained for all processed documents and information.

Compliance:

All Schumacher Clinical Partners employees will adhere to policies and procedures, including the Schumacher Clinical Partners Corporate Compliance Program, and comply with applicable local, state, and federal laws.

Disclaimer:

The above statements describe the essential functions of the job and may not include all work requirements. They are subject to change due to reasonable accommodation or other reasons.

Pay Range:

This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.

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We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.

Visit our website for further information. https://myscpbenefits.com/

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