Adventist Health

Compensation

Full Description

All the benefits and perks you need for you and your family: · Benefits from Day One · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. Shift: Monday- Friday Full time Job Location: Remote The role you will contribute: Responsible for analyzing payer account reconciliation discrepancies and identifying variance causes for the resolution of payer denials and expected reimbursement underpayments. This position recognizes payer trends to maximize expected reimbursement for managed care contracts. This role handles billing and A/R follow-up, denial recovery, prevention, and appeal writing activities while adhering to the rules and regulations of all government and Managed Care payers. In addition, this position performs outgoing calls, corresponds with patients and insurance companies to obtain necessary information, and communicates with other departments to ensure accurate and timely claim adjudication. This role requires a deep understanding of payer contracts and adherence to all applicable local, state, and federal regulations and accrediting bodies. The value you will bring to the team: Reviews and resolves accounts daily, focusing on complex denials across multiple payers and regions. Conducts account history research, including patient encounters, charge/payment histories, and payer remittance advice. Follows up on claims to review contract discrepancies and account balances, attaching documentation, amending data, gathering additional information, and resubmitting corrected claims. Reviews EOBs or contacts payers for denied claims status. Defends and appeals denied claims by researching root causes, collecting necessary information, adjusting accounts, resubmitting claims, and following up to ensure adjudication. Communicates denial root causes and resolutions to leadership. Aggregates data and sends complete appeal packets via mail, fax, or Federal Express using the denials management tool. Identifies system loading discrepancies and refers them for correction. Understands managed care payment methodologies and principles, interpreting multiple payment methodologies for various payer types, including Commercial Managed Care, Managed Medicare, Managed Medicaid, and other governmental payers. Identifies payer performance trends by analyzing data on claim approvals, denials, and payment timelines. Reviews denial management correspondence to understand reasons for claim denials and develops strategies to address them. Handles auditing bodies' correspondence by providing necessary documentation and responses. Other duties as assigned. The expertise and experiences you’ll need to succeed: · High School Grad or Equivalent · 1+ Work Experience · Basic understanding of an explanation of benefits (EOB) · Basic knowledge of CPT, ICD-10, and HCPCS coding standards · Strong organizational skills · Strong keyboard and 10 key skills · Proficiency in Microsoft Suite applications, specifically Excel and Word applications, as well as Outlook · Ability to communicate effectively in written and oral form with diverse populations · Interpersonal skills to promote teamwork throughout the Denials Management team · Ability to multitask and function in a fast-paced environment · Ability to prioritize and problem-solve · Self-motivated and able to work with multiple and multi-functional teams · Work within very tight time frames · Comfort with interpreting payer contractual language · Ability to navigate payer website/portals to perform remittance research and gather additional information needs · Experience in healthcare claims processing and proficiency with medical billing and remittance forms and processes, including 835 and 837 files, and UB04 and CMS-1500 (HCFA) forms · Technical proficiency within Patient Accounting systems and denial management workflow technology; position requires ability to navigate various modules within applicable technologies to perform account research