Position Requirements

The Rejections and Denials Specialist will be responsible to work the denied eligibility claims for all assigned payers and states. This will include working within multiple work queues, contact payers online or by phone, updating accounts as needed, and identifying carrier-related denial trends. This position will need to maintain a thorough knowledge and understanding of all charge corrections and FSC transfers, on top of understanding the differences. Familiarity with anesthesia modifiers, procedure codes and diagnostic codes. In addition, there may be projects that may require a manual process by reviewing and working off spreadsheets.

PRIMARY RESPONSIBILITIES:

• Analyzes patient insurance to identify the correct insurance plan(s) was selected by reviewing the plan selection and any necessary documents or payor portals. Accurately documents all the proper steps to ensure accounts are worked correctly in a timely manner. Has the able to troubleshoot and resolve issues before they occur by collecting all the appropriate information to create useful error output
• Identifies billing errors and charge correction errors through research to resolve claim errors in a timely manner for the more complex eligibility tasks.  This could include contacting payers, referring office/hospital, or patients to obtain medical insurance information.
• Follow the department directions, TIP sheets, procedure manuals, and departmental policy and procedures.
• Evaluate insurance payor set up with the billing system to confirm the eligibility payor connection logic. Assist management in optimizing the efficiency and quality of eligibility team.
• Assist with training and educating new and established staff members

QUALIFICATIONSREQUIRED QUALIFICATIONS:

• High school diploma or equivalent certification required

DESIRED/PREFERRED QUALIFICATIONS:

• 3 plus years of experience with eligibility related knowledge
• Knowledge of understanding guidelines for Medicare/Medicaid, government plans, HMOs, and PPOs
• At least one year of exceptional customer service skills
• 3 plus years of denials management experience
• Strong computer skills (including MS Word and Excel)
• Ability to think critically and resolve accounts with minimal supervision
• Has a strong working knowledge of billing procedures, insurance reimbursement and guidelines preferably in a medical or anesthesia setting
• Ability to multitask, work in a team as well as independently
• Must be able to communicate effectively and professionally to patients, insurance companies along with co-workers and management
• Strong oral and written communication skills preferred
• Ability to perform at a high level of productivity and quality
• Work in collaboration with Team Lead to improve processes
• Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance.
• Exceptional organization and time management skills
• Must have professional and effective oral communications with co-workers, insurance representatives, clients, and patients

Total Rewards

• Salary: $19-22 hourly
• Generous benefits package, including:
• Paid Time Off
• Health, life, vision, dental, disability, and AD&D insurance
• Flexible Spending Accounts/Health Savings Accounts
• 401(k)
• Leadership and professional development opportunities

EEO Statement

North American Partners in Anesthesia is an equal opportunity employer.