AR Complex Clinical Denials Specialist

Job description

Essential Duties & Responsibilities

Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
Update patient demographics/insurance information in appropriate systems
Research/ Status unpaid or denied claims
Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
Research EOBs for payments or adjustments to resolve claim
Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission.
Access client systems for payment, patient, claim and data info
Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
Secure needed medical documentation required or requested by third party insurance carriers
Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
Perform other related duties as required

Minimum Requirements & Competencies:

3+ years of medical collections, denials and appeals experience
Must have atleast 6 months of EPIC tool experience
Experience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessity
Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
Intermediate knowledge of third-party billing guidelines
Intermediate knowledge of billing claim forms (UB04/1500)
Intermediate knowledge of payor contracts- commercial and government
Intermediate Working Knowledge of Microsoft Word and Excel
Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
Intermediate of DDE Medicare claim system
Intermediate Knowledge of government rules and regulations
Must be willing to work onsite in Ortigas, Pasig City.

Enjoy the ff. Perks and Benefits:

15% Night Differential
HMO Benefits after 30 days + Add Up to 2 Dependents
Retirement Benefits
24 Leave Credits per year, Convertible to Cash
Wholistic Employee Wellness Program
Job Type: Full-time