Complex Denials Specialist, Accounts Receivable

Freddie Mac; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A healthcare revenue cycle improvement company seeks a Medical Insurance Accounts Receivable Representative. The role involves collecting receivables and managing claims within compliance. Ideal candidates have experience in medical collections, ICD knowledge, and familiarity with billing systems. The compensation ranges from $18.00 to $22.00 per hour depending on experience and location.

Qualifications

• 2-3 years of medical collections, denials, and appeals experience.
• Experience with various denial types including DRG downgrades and medical necessity.

Responsibilities

• Ensure timely collection of outstanding healthcare insurance receivables.
• Verify eligibility and authorization with insurance carriers.

Skills

Medical collections

Denials and appeals

ICD-10

CPT

HCPCS

NCCI

Billing claim forms

Payor contracts

Microsoft Word

Microsoft Excel

Health information systems

Job description

Here at Savista, we enable our clients to navigate the biggest challenges in healthcare: quality clinical care with positive patient experiences and optimal financial results. We partner with healthcare organizations to problem solve and deliver revenue cycle improvement services that enable their success, support their patients, and nurture their communities, all while living our values of Commitment, Authenticity, Respect and Excellence (CARE).

Savista partners with healthcare providers to improve their financial strength by implementing integrated spend management and revenue cycle solutions that help control cost, improve margins and cash flow, increase regulatory compliance, and optimize operational efficiency.

The Medical Insurance Accounts Receivable Representative is responsible for ensuring the timely collection of outstanding government or commercial healthcare insurance receivables.

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

• 2-3 years of medical collections, denials and appeals 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.)

Preferred Requirements & Competencies

• Intermediate knowledge of one or more of the following Patient accounting systems - EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
• Intermediate of DDE Medicare claim system
• Intermediate Knowledge of government rules and regulations

Savista is required by state specific laws to include the salary range for this role when hiring a resident in applicable locations. The salary range for this role is from $18.00 to $22.00. However, specific compensation for the role will vary within the above range based on many factors including but not limited to geographic location, candidate experience, applicable certifications, and skills.

SAVISTA is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

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