Denials & Reimbursement Specialist

Detroit Institute of Arts; Florida; In loco; USD 42.000 - 54.000; Tempo pieno

Descrizione del lavoro

Pediatric Associates is seeking a Reimbursement Specialist in Hollywood, FL to analyze billing processes and manage claims denial handling for Government and third-party payers. You will validate eligibility, correct coding errors, resubmit denied claims, and monitor payer policies to maximize timely, accurate reimbursements.

This nonpatient-facing role requires at least 1 year of insurance/collection experience in a medical setting and strong organizational and interpersonal skills to work

Competenze

• High school diploma/GED or equivalent.
• Minimum of 1 year of insurance/collection experience in a medical environment preferred.
• Knowledge of billing and collection policies and procedures (HMO, PPO, POS, Medicaid, etc.).
• Strong interpersonal skills and ability to work as part of a team in the Business Office.

Mansioni

• Processes correspondence related to assigned contracted and/or non-contracted insurance carriers including self-pay accounts.
• Researches denied and improperly processed claims by contacting assigned carriers to ensure proper processing of said claims.
• Identifies and corrects any claim processing errors due to data entry, verification, coding and/or posting.
• Resubmits improperly paid/denied claims to the carrier for proper payment in a timely manner.
• Monitor payer payment policies for each carrier to ensure guidelines are followed.
• Responsible for validating appeal opportunities, creating appeal letters, and submitting appeals in a timely manner.
• Communicate and elevate denial trends, short payments, or payer policies to Management.
• Other duties as assigned, including cross training in other functional areas.

Conoscenze

Billing policies

Interpersonal skills

Multi-tasking

Organizational skills

Formazione

High school diploma/GED

Descrizione del lavoro

Pediatric Associates is seeking a Reimbursement Specialist in Hollywood, FL to analyze billing processes and manage claims denial handling for Government and third-party payers. You will validate eligibility, correct coding errors, resubmit denied claims, and monitor payer policies to maximize timely, accurate reimbursements.

This nonpatient-facing role requires at least 1 year of insurance/collection experience in a medical setting and strong organizational and interpersonal skills to work