Denials & Follow-up Rep- Managed Medicare- Remote

ochsner; Louisiana (MO, LA); Remote; USD 42,000 - 54,000; Full time

Job summary

Ochsner in Louisiana seeks a Revenue Cycle Specialist to resolve insurance account receivables and manage collections and billing activities.

You will verify insurance data, follow up on claim status, and communicate with payors, patients, and vendors. Strong data-entry, communication, and multi-tasking are essential in a fast-paced setting.

Qualifications

• Must have data entry and retrieval skills.
• Effective verbal and written communication to varied audiences.
• Proficient with Windows-style applications and software packages.

Responsibilities

• Perform account research via phone and payor websites to obtain payment.
• Verify and update insurance/demographic information to resolve payment barriers.
• Follow-up with payors and check claim status throughout payment process.
• Appeal denials when needed and determine appeals scope.
• Maintain knowledge of payor guidelines for accurate reimbursement.

Skills

Interpersonal skills

Verbal communication

Written communication

Data entry

Windows applications

Education

High School diploma or equivalent

Associates or Bachelor degree (preferred)

Tools

EPIC system

Windows/Office suite

Job description

Exceptional care starts with exceptional people.

For us, this is more than a job- it's a calling. It's waking up each day, looking for ways to make a difference with a compassionate, inclusive and talented team. Ochsner empowers you to discover your passion, reach your potential, and Pursue Your Purpose. Exceptional care starts with exceptional people and teams. Together we are leading the way.

This job is primarily responsible for resolving all outstanding insurance account receivables. Responsibilities include, but are not limited to, performing collection and billing activities related to account resolution, and communicating with payors (Government and Commercial), clients, reimbursement vendors, and other external resources such as patients. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.

This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.

Education

• Required - High School diploma or equivalent
• Preferred - Associates Degree or Bachelor Degree

Work Experience

• Required - 1 year related experience in related hospital, clinic, medical office, business services/revenue cycle, front line registration, financial counseling, banking and/or customer service related job
• Preferred - Prior experience working with EPIC system

Knowledge Skills and Abilities (KSAs)

• Must have computer skills and dexterity required for data entry and retrieval of required job information.
• Effective verbal and written communication skills and the ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
• Must be proficient with Windows-style applications, keyboard, and various software packages specific to role.
• Strong interpersonal skills.
• Ability to multi-task.
• Ability to perform effectively in a fast paced ever changing environment.
• Ability to remain calm and professional in high pressure/stressful situations regarding patient financial and medical conversations.
• Reliable transportation to travel to other facilities to fill in as needed.

Job Duties

• Performs account research with internal and/or external resources via phone and payor websites to determine status of the account with the expected result of obtaining payment of the account.
• Verifies and/or updates insurance and demographic information for accuracy to resolve barriers in receiving payment of the account.
• Follows-up with payors and checks claim status as needed throughout the payment process.
• Appeal denials when needed throughout the payment process and determines when appeals should be sent for further research and/or review.
• Maintains knowledge of differing payor guidelines to ensure accurate reimbursement by various resources, such as department meetings and updates on payor websites.
• Identifies trends that may cause or are causing various types of issues on assigned accounts and reports to leader with recommendations for system improvements/edits.
• Other related duties as required.

The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.

Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.

This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.

The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Light Work - Exerting up to 20 pounds of force occasionally, and/or up to 10 pounds of force frequently, and/or a negligible amount of force constantly (Constantly: activity or condition exists 2/3 or more of the time) to move objec