Medical Claims Examiner- Trainer - Plano, United States - ERISA Recovery

Description

ONSITE POSITION

ERISA Recovery, a frontrunner in the Federal ERISA appeals process for collecting complex and aged claims, seeks a proactive Denied Claims Trainer who specializes in overturning denied claims. You will develop, implement, and facilitate a claims training program with an emphasis on appeals and denials. We are looking for a candidate with in-depth knowledge in the insurance industry and a proven ability to train employees in a fast paced environment. This role is key to securing reimbursement and minimizing organizational write offs.

Key Responsibilities

• Subject Matter Expert: Complete understanding of Surgical Claims, DRG- **Transplant and Cancer claims process is a plus ** Maintains working knowledge of applicable insurance carriers timely filing deadlines, claims submission processes, and appeal processes and escalates timely filing requests to Leadership.
• Track Denial Trend Track denial trends and recovery strategies and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts.
  
• Team Coaching and Standards Compliance: Provide ongoing coaching and training to ensure team adherence to standards, regulations, and best practices.
• Train new employees teach strategies for prioritizing cases, reviewing account history, remit, and payer history to determine the appropriate challenge and appeal strategy.
  
• Collaborative Teamwork Enhancement: Foster collaboration with back-office and other departmental teams for a unified approach to meeting organizational objectives.
• Billing and Coding Understanding: Knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes
• Revenue Cycle: Complete understanding of the revenue cycle process to include prior authorization, billing, insurance appeals, and hospital collections
• ERISA Federal Guidelines: Interpret and apply ERISA guidelines to determine claim eligibility and benefits.
• Apply prior knowledge of denials to assess and ensure services/items billed are reasonable and necessary, and supported by Self-funded medical policies
• Report Findings: Assist department leadership with research, analysis and special projects. Attends necessary payer meetings to escalate denials issues. Participate in huddle meetings and sharing the details of cases worked

Essential Skills & Qualifications

• Bachelor's Degree preferred
• Expertise in data analysis for performance management and operational enhancement.
• Exceptional leadership, team management, and interpersonal communication skills.
• Detail-oriented with the capability to oversee multiple projects and issues simultaneously, ensuring accurate and timely completion.
• Proficient in MS Office suites, Electronic Health Record systems, and Insurance Claims Portals.
• A comprehensive understanding of hospital claims denials, medical terminology, CPT codes, modifiers, diagnosis codes, and payor contracts.
• In-depth knowledge of collection laws and regulations, as well as understanding of financial principles related to hospital appeals.

Please note: Only applicants with vast knowledge of hospitals claims denials need apply.

ERISA Recovery believes in a work-life balance and offers a competitive compensation package including a flexible work schedule, 401k, bonus plan and medical and dental benefits.

ERISA Recovery is an Equal Opportunity Employer