- High school graduate or equivalent. Associates degree or higher preferred.
- Minimum of at least 3 years experience in a hospital business or medical office environment performing billing and/or collections.
- Advanced knowledge of 1500 and/or UB-04 and Explanation of benefits (EOB) interpretation.
- Intermediate knowledge of CPT and ICD-10 codes.
- Advanced knowledge of insurance billing, collections and insurance terminology.
- Advanced knowledge of reading and understanding managed care contracts and federal and state regulations.
- Maintain professionalism and create a positive experience for both internal and external customers.
- Intermediate PC experience required with knowledge of Excel and Word applications.
- Excellent verbal and written communication skills.
- Strong critical thinking and analytical skills.
- Self-motivated.
- Advanced business letter writing skills to include correct grammar and punctuation.
- Knowledge of reimbursement methodologies for various payer groups.
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Denials Management
2 weeks ago
Baptist Health - Alabama Montgomery, United StatesBaptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at · The Denial ...
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Denial Management Nurse
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Jackson Hospital Montgomery, United States Full timeJob Description · The Denial Management Nurse is responsible for developing and implementing a centralized program to promote greater efficiency with completing, tracking, and reporting clinical denial reviews to determine appropriate appeal of patient accounts. This individual ...
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Director of Denials Management
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Baptist Health Montgomery, United States Full timeJob Description - Director of Denials Management & Prevention DIR Job Description Director of Denials Management & Prevention DIR Description Qualifications Education / Experience: Bachelor's degree in a business or healthcare related field or equivalent education and experienc ...
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Denial Management Nurse
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Jackson Hospital and Clinic Montgomery, United StatesJob Description · The Denial Management Nurse is responsible for developing and implementing a centralized program to promote greater efficiency with completing, tracking, and reporting clinical denial reviews to determine appropriate appeal of patient accounts. This individual ...
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Management and Prevention- AL
2 weeks ago
American Consultants Montgomery, United StatesJob Description · Job DescriptionDirector of Denials Management and Prevention- AL · American Consultants is looking for a permanent Director of Denials Management and Prevention for a facility in Alabama. · Summary: · The Director, Denials Management & Prevention shall oversee t ...
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Medical Claims Analyst
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Career Personnel Montgomery, United StatesJob Description · Job DescriptionPosition Summary: · Claims Analyst is responsible for timely follow up and resolution of accounts with Health · Insurance companies and other third-party payers, insurance payer correspondence and appeals. · Responsibilities: · Insurance follow-u ...
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Medical Biller/Coder
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Southern Specialty Physicians Montgomery, United StatesJob Description · Job DescriptionSummary of Position: · Southern Specialty Physicians is looking to expand our team with a Medical Biller/Coder. This role will require assisting the Billing/Coding Supervisor with claim submission and corrections, denials management, A/R follow-up ...
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Billing Coordinator
2 weeks ago
Baptist Health - Alabama Montgomery, United StatesBaptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at · The Billing ...
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Billing Analyst
3 weeks ago
Baptist Health Montgomery, United StatesBaptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at · The Billing ...
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Field Adjuster
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CCMS & Associates Montgomery, United StatesJob Description · Job DescriptionCCMS & Associates is looking for a 1099 Field Adjuster in Alabama, specifically the Montgomery area. We are answering a call to action to add to our existing roster. The time is now to get on with our innovative team · We are seeking a residential ...
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School Operations Manager at Bellingrath
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Phalen Leadership Academies Montgomery, United StatesJob Description · Job DescriptionThe Opportunity: PLA's School Operations Managers (SOMs) are excellent at providing oversight of non-instructional functions such as campus safety, maintenance, food services, etc. The SOM will lead the implementation and maintenance of clear oper ...
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Billing Coordinator
3 weeks ago
Baptist Health Montgomery, United StatesBaptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at · The Billing ...
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Financial Clearance Analyst Team Lead
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Senior Partner Marketing Manager, MSPs
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Assisted Living Director of Compliance
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Surety Senior Claims Professional Attorney
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Vice President, Corporate Marketing
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Phalen Leadership Academies Montgomery, United StatesThe Opportunity: PLA Assistant Principals are instrumental in supporting PLA's vision which includes creating an environment of high standards for both our staff and our scholars. As an Assistant Principal, you will work closely with the principal to manage all the functions of o ...
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Case Manager, Ltss Rn
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multi-line adjuster
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Denials Management - Montgomery, United States - Baptist Health
Description
Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us atThe Denial Management Specialist shall be responsible to validate dispute reasons, escalate payment variance trends or issues to management, and generate appeals for denied or underpaid claims. This individual will be expected to be a subject matter expert, to display a certain amount of knowledge and skill, in order to resolve complex and aged accounts with minimal or no assistance necessary. Resolution of accounts may include research of payer and governmental regulations and billing rules, payment research, review of all aspects of the claim such as member information, CPT and diagnosis codes, review of medical records, analysis of managed care contracts and review of the chargemaster. The Specialist will exhaust all appeal efforts based on the dispute reason and according to specific payer guidelines for appeal and dispute resolution. This individual will have in-depth knowledge of payer contracts, billing rules, and administrative guidelines in order to effectively review and analyze denials and underpayments. The Specialist will provide meaningful feedback and recommendations to Managed Care, Revenue Integrity, and Leadership teams regarding any trends or issues and will escalate as needed through payer provider advocates and contracting teams. Additionally, this individual will work collaboratively with other areas in attempts to resolve or minimize ongoing denials and underpayments. The Specialist will accurately and thoroughly document all pertinent collection activity performed. To stay current on regulations, they will participate in continuing education related to payer and governmental policies and guidelines and assist in providing integral information to leadership, managers and trainers to ensure information is disseminated within Patient Financial Services as needed. This position may have additional duties assigned that are within scope of the role.Description
