PB & HB Coding Denials & Edits Specialist (AAPC or AMHIMA cert required)

CorroHealth; United States; Remote; USD 30,000 - 41,000; Full time

Job summary

CorroHealth, Inc. is seeking an AR Specialist to ensure timely collections of government or commercial healthcare receivables. You will follow up on outstanding accounts, verify eligibility, and process denials and appeals with attention to detail and compliance.

The role requires at least 3 years in healthcare AR, active certification, and strong Excel/Outlook/Word skills. You will interact with payers, patients, and providers while maintaining professional communication standards.

Qualifications

• 3+ years of accounts receivable experience within the healthcare revenue cycle.
• Must have an active AAPC or AMHIMA certification.
• 2+ years of experience with healthcare and/or insurance billing and processing.
• Experience with professional physician and hospital facility claims.
• Ability to read and interpret an EOB.
• Knowledge and understanding of UB04 and HCFA 1500 forms.
• High School diploma.
• Proficiency with Outlook, Excel, and Word.
• Must be able to perform basic formulas.
• Strong communication and interpersonal skills.

Responsibilities

• Performs duties as assigned including interacting with insurance plans, patients, physicians, attorneys and team members.
• Assigns accurate codes for inpatient and outpatient physician or hospital-based claims.
• Work denials and appeals by applying edits as needed.
• Verify patient eligibility and/or authorization for services by payer research or calls.
• Update patient demographics and insurance information in systems.
• Research and status unpaid or denied claims.
• Monitor claims for missing information and control numbers.
• Research EOBs for payments or adjustments to resolve claims.
• Contact payers to secure payment of claims.
• Access client systems for information on payments and open claims.
• Follow guidelines for prioritization and deadlines.
• Secure needed medical documentation.
• Obtain billing guidelines by researching manuals.
• Write appeal letters for technical appeals.
• Verify accuracy of underpayments by reviewing contracts and data.
• Prepare claims for clinical audit processing if applicable.

Skills

A/R experience

Healthcare billing

Analytical thinking

Communication skills

Interpersonal skills

Independent work

Education

AAPC or AHIMA certification

High school diploma

Tools

Outlook

Excel

Word

Job description

About Us

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY

Reporting to the Manager, AR Services the AR Specialist is responsible for ensuring the timely collections of outstanding government or commercial healthcare insurance receivables. The AR Specialist follows up on outstanding A/R for all payers and/or including self pay and/or including resolution of denials.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Performs duties as assigned which includes interacting with insurance plans, patients, physicians, attorney’s and fellow Team Members as needed.
• Assigns accurate codes for inpatient and outpatient physician or hospital based claims.
• Work denials and appeals assigning edits as needed.
• Verifies or obtains patient eligibility and/or authorization for healthcare services performed by searching payer web sites or client eligibility systems, or by conducting phone conversations with the insurance carrier or healthcare providers.
• Updates patient demographics and/or insurance information in appropriate systems.
• Conducts research and appropriately statuses unpaid or denied claims.
• Monitors claims for missing information, authorization and control numbers (ICN//DCN).
• Research EOBs for payments or adjustments to resolve claims.
• Contacts payers by phone or through written correspondence to secure payment of claims.
• Accesses client systems for information regarding received payments, open claims and other data necessary to resolve claims.
• Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems.
• Secures medical documentation as required or requested by third party insurance carriers.
• Obtains billing guidelines and requirements by researching provider billing manuals.
• Writes appeal letters for technical appeals.
• Verifies accuracy of underpayments by researching contracts and claims data.
• In the event of an authorization, coding, level of care and/or length of stay denial, prepares claims for clinical audit processing.

KNOWLEDGE, SKILLS & ABILITIES

• 3+ years of accounts receivable experience within the healthcare revenue cycle.
• Must have an active AAPC or AMHIMA certification.
• 2+ years of experience with healthcare and/or insurance billing and processing.
• Experience with professional physician and hospital facility claims.
• Ability to read and interpret an EOB.
• Knowledge and understanding of UB04 and HCFA 1500 forms.
• High School diploma.
• Proficiency with Outlook, Excel, and word. For example; must be able to manage email, outlook calendar and tasks.
• Must be able to do basic formulas such as, add, subtract, multiplication, etc.
• Ability to communicate in a professional and clear manner.
• Strong interpersonal skills.
• Ability to work independently, have analytical and critical thinking skills.

PHYSICAL DEMANDS

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines. A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.

ABOUT CORROHEALTH

CorroHealth sits at the center of the revenue cycle revolution. Fundamental operations of the revenue cycle are supported through our expert teams while we recast the role of clinicians through automation. This shift to a true clinical revenue cycle helps us achieve our core purpose – exceed client financial health goals. For each patient population, CorroHealth automates key clinical aspects of the cycle. Our platforms focus on capture and application of clinical documentation while easing the burden on physicians. Scalability is prioritized in the support of client program operations. As with most revenue cycle partners, our skilled and enthusiastic team is available to outsource any portion of the cycle. However, we can also complement client programs with additional expert support or upskill existing client teams to meet program demands. Whether our team is deployed directly, or automation is incorporated for a more programmatic solution, CorroHealth delivers. CorroHealth has acquired Xtend Healthcare! For more information, please visit https://corrohealth.com. Applicants will only receive job-related emails from the domain @corrohealth.com. Additionally, it is important to emphasize that CorroHealth will never ask for money in return for a job offer.