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**Responsibilities**:
- Reviews and validates EOBs, denial reasons, carrier and ensures coding is accurate and reflects the denial reasons
- Coordinates and plays role with clinical consultations when necessary
- Generate an appeal based on the dispute reason and contract terms specific to payer
- Prepare and submit insurance claim appeal letters
- Follow specific payer guidelines for appeals submission
- Escalate exhaustive appeal efforts for resolution
- Work payer projects as directed
- Coordinate and document status of appeals until final resolution of the denial
- Track and monitor increases in revenue from appeals process
- Identify denial & variance trends including internal collaboration to create the data analysis and data input methods
- Document the status of action steps taken to resolve outstanding claims
- Identify billing errors for correction and re-submission to insurance companies
- Follow up on payment errors, low reimbursement, and denials
- Identify and propose recommendations for improving workflow management
Additional tasks may be assigned from time to time dependent on current or projected business need.
**Requisitos**:
- 4+ years of Accounts Receivable follow up with health insurance carriers on claims (direct contract with insurers)
- Experience and insightful to issues with payment issues with providers operating outside of contractual payer agreements (out-of-network).
- Full understanding of the insurance denials / appeals process
- Excellent computer skills and especially proficient in utilizing Microsoft Office tools Excel, Outlook, Word, PowerPoint.
- Self-motivated, ability to work independently and work with remote colleagues
- Out of the box thinker to determine best ideas for department improvements
- Ability to work with a sense of urgency
- Comfortable working in a high-stress environment
- Ability to manage time and prioritize tasks without direct supervisor’s input
- Highly organized and detail oriented
- Strong oral and written communication skills
- Exhibit professionalism and trustworthiness.
- High School Diploma or GED
Beneficios
- A Monthly $50 perfect attendance bonus (If you don't miss a day and are always on time during the month)
- Private Health and Life Insurance paid by the company (when you have your 3 months in the company)
- Parking: the building where we are located, has parkings for our employees paying $37.50 biweekly or per quincena (you will need to pay that per quincena).
- Referral Bonus: $200 if you refer someone and is hire. (You received the bonus when that person has 3 months in the company)
- Monthly Activities (Fun Activities like Karaoke, Board Games Afternoons, Sports, Yoga, Zumba, and Social Responsibility activities)
- Free Mental Health Assistance
