- Research and resolve all types of denials efficiently and accurately, which includes but not limited to coordination of benefits (COB), insurance eligibility, coding (e.g., modifiers, diagnoses, CCI edits), billing (e.g., NPI, POS, DOS).
- Research and resolve insurance and patient credits timely and accurately.
- Follow insurance appeal standards or protocols, establish an appeal correspondence to petition the denial as incorrect or inappropriate and for the third-party carrier to reconsider and adjudicate the claim correctly. May inquire with assigned coder for education or letter of appeal, if outside the scope of the AR Specialist.
- Document all actions and communications taken regarding each account/session/encounter in the designated fields in the practice management system (PMS).
- Identify and track denial trends by payer, provider, and code.
- Identify billing-related issues and work with appropriate internal teams to resolve the identified issue(s) in a timely manner.
- Must stay up to date with industry trends and changes that impact Accounts Researching. This may include seminars, training, and reading material. It is the employee's responsibility to maintain one's AR knowledge and learn specific required areas, such as basic coding.
- Ensure secondary claims are filed with the appropriate primary insurance EOB attachment in a timely and accurate manner.
- Answer customer service inquiries professionally, timely and efficiently. Make certain the inquiry is completed, closed or followed up on until closure happens. Document the guarantor/patient's account in detail.
- Handle and expedite distinctive cases include bankruptcy, charity, statements, tax billing document, refunds and other items, should be processed accurately but expeditiously and follow-through. Follow the designated processes for these distinctive cases.
- Collect outstanding balances must be done professionally and with tact. Posting of payment done accurately, timely and according to protocol.
- Handle all claim denials appropriately and according to department standards.
- Other duties as assigned.
- Understand basic coding to work coding denials successfully.
- Must be able to communicate effectively in English, verbally and written. Additional languages desirable.
- Excellent customer service and phone etiquette skills.
- Must be able to maintain a high degree of confidentiality and work well under productivity standards.
- Able to prioritize and balance workload on short and long-term company needs.
- Must be able to work independently and be able to solve problems efficiently and accurately.
- Able to create channels of communication to obtain information necessary to perform job tasks.
- Strong organizational skills with the ability to prioritize a high-volume workload.
- Helpful attitude, positive teamwork spirit with a willingness to help.
- High School Diploma or Equivalent required.
- Minimum of 2 years of experience in medical field/accounting/accounts receivable.
- Certifications in Medical Billing and Coding highly desirable.
-
Kim Lab: Junior Research Specialist
4 weeks ago
University of California Santa Cruz Santa Cruz, United StatesKim Lab: Junior Research Specialist (Junior Specialist Rank) Salary range: Commensurate with qualifications and experience. The posted UCSC Salary Scales set the minimum pay determined by rank and step at appointment. See the scale titled, Represente Research, Specialist, Junior, ...
-
Residency Director
3 days ago
The People Link Corp Monterey, CA, United States Full timeEmployer Description: Our Physical Therapists are tops in their field As a well-educated group of physical therapy doctors, they are committed to constant improvement in the areas of their clinical expertise, exercise interventions, advanced rehabilitation techniques, and the la ...
-
senior psychologist, correctional facility
2 weeks ago
State of California Monterey, United StatesJob Posting: Senior Psychologist, CF (Specialist); Salinas Valley State Prison, Soledad · California Correctional Health Care Services · JC Senior Psychologist, CF (Specialist); Salinas Valley State Prison, Soledad · SENIOR PSYCHOLOGIST, CORRECTIONAL FACILITY (SPECIALIST) $10 ...
-
senior psychologist, correctional facility
3 weeks ago
State of California Monterey, United StatesJob Posting: Senior Psychologist, CF (Specialist); Salinas Valley State Prison, Soledad · California Correctional Health Care Services · JC Senior Psychologist, CF (Specialist); Salinas Valley State Prison, Soledad · SENIOR PSYCHOLOGIST, CORRECTIONAL FACILITY (SPECIALIST) $10 ...
-
staff services analyst
3 weeks ago
State of California Monterey, United StatesJob Posting: SSA/AGPA-Salinas Valley State Prison, Soledad · California Correctional Health Care Services · JC SSA/AGPA-Salinas Valley State Prison, Soledad · STAFF SERVICES ANALYST $1, $2,958.00 per Month · Final Filing Date: 5/16/2024 · Application Methods: Electronic (U ...
-
senior psychologist, correctional facility
1 week ago
California Correctional Health Care Services Monterey, United StatesJob Description and Duties · Under the general direction of the Chief Psychiatrist or Chief Psychologist, the Senior Psychologist (Specialist) is responsible for the evaluation, diagnosis, and treatment of inmates in the Correctional Treatment Center (CTC). This includes crisis ...
-
Head Athletic Trainer
3 weeks ago
California State University Montery Bay Monterey, United StatesClassification: Head Athletic Trainer · Hours: Full-time / 40 hours per week · FLSA: Exempt · Anticipated Hiring Salary Range: $6,710* mo. · CSU Salary Schedule · *CSUMB provides pay scales representing its good faith estimate of what the university reasonably expects to pa ...
-
Cardiology
2 weeks ago
Provider Solutions & Development Seaside, United States Part timeCardiology physician employment in Oregon : Providence Heart Institute is seeking board-certified/board-eligible, Per Diem Non-Invasive Cardiology physician to join a growing practice in Seaside, Oregon. · Per Diem position · Where Youll Work · The Providence Heart Institute is a ...
-
Cardiology
3 weeks ago
Provider Solutions & Development Seaside, United States Part timeCardiology physician job in Oregon : Providence Heart Institute is seeking board-certified/board-eligible, Per Diem Non-Invasive Cardiology physician to join a growing practice in Seaside, Oregon. · Per Diem position · Where Youll Work · The Providence Heart Institute is an integ ...
-
Senior Medi-Cal Contracts Analyst
3 hours ago
Central California Alliance for Health Monterey, United StatesWe have an opportunity to join the Alliance as a · Senior Medi-Cal Contracts Analyst, internally referenced as · Senior Provider Network Development Specialist · supporting the brand new team focused on recruitment and expansion of our provider network for the Provider Service ...
-
Central California Alliance for Health Monterey, United StatesWe have an opportunity to join the Alliance as a Senior Provider Network Development Specialist supporting the brand new team focused on recruitment and expansion of our provider network for the Provider Services Department. This position has regular/ frequent in-community requir ...
-
Senior Technical Support Specialist
2 weeks ago
Pebble Beach Resorts Del Monte Forest, United States Full timeCompany Background: · For over a century, friends and family, celebrities and athletes, world travelers and locals alike, have flocked to Pebble Beach Resorts. This stunning slice of Californias Monterey Peninsula is a wondrous place that we are proud to share. Pebble Beach Comp ...
-
Program Support Specialist
2 weeks ago
@Orchard Monterey, United StatesJob Description · Job DescriptionProgram Support Specialist · Monterey, CA@Orchard LLC is actively seeking to engage an experienced Program Support Specialist for a project in support of NOAA's Monterey Bay National Marine Sanctuary (MBNMS). The MBNMS provides resource protection ...
-
Open Position
4 weeks ago
Sunbelt Staffing Monterey, United StatesJob Description · Job DescriptionMinimum 1+ years Behavior Specialist experience required. · Sunbelt is seeking a dedicated BCBA to join our team and contribute to our mission of empowering individuals and their families through evidence-based interventions. We care about our edu ...
-
Multimedia & Production Support Specialist
2 days ago
JTG Monterey, United StatesProduction Support Specialist (Editor) · Ongoing Contract · JTG inc. is seeking a highly-skilled production support specialist (editor) to join our Curriculum Support team. Applicants should be experienced in helping customers to conceptualize end products, designing and develo ...
-
Open Position
2 weeks ago
Sunbelt Staffing Monterey, United StatesJob Description · Job DescriptionMinimum 1+ years Behavior Specialist experience required. · Sunbelt is seeking a dedicated BCBA to join our team and contribute to our mission of empowering individuals and their families through evidence-based interventions. We care about our edu ...
-
Marketing Specialist
2 days ago
California State University Monterey, United StatesMarketing Specialist · Job no: · 538477 · Work type: · Staff · Location: · Monterey Bay · Categories: · Unit 9 - CSUEU - Technical Support Services, Administrative, Probationary, Full Time · Classification: · Public Affairs/Communications Specialist III -Exempt · Hours: · ...
-
Senior Technical Support Specialist
1 day ago
Pebble Beach Pebble Beach, United States Full timeCompany Background: · For over a century, friends and family, celebrities and athletes, world travelers and locals alike, have flocked to Pebble Beach Resorts. This stunning slice of Californias Monterey Peninsula is a wondrous place that we are proud to share. Pebble Beach Compa ...
-
Senior Provider Network Development Specialist
2 weeks ago
Central California Alliance for Health Monterey, United StatesWe have an opportunity to join the Alliance as a Senior Provider Network Development Specialist supporting the brand new team focused on recruitment and expansion of our provider network for the Provider Services Department. · This position has regular/ frequent in-community req ...
-
Senior Medicare Contracts Analyst
1 week ago
Central California Alliance for Health Monterey, United StatesWe have an opportunity to join the Alliance as a · Senior Medicare Contracts Analyst, internally referenced as · Senior Provider Network Development Specialist · supporting the brand new team focused on recruitment and expansion of our provider network for the Provider Service ...
Accounts Research Specialist - Monterey, United States - Cypress Healthcare Partners
Description
Job Description
Job DescriptionPOSITION/JOB SUMMARY:
The Accounts Research Specialist are responsible for accounts research of physician services by researching denials for resolution and providing customer service to patients, insurance companies, third parties, providers and their offices. The employee will appeal denials appropriately, identify and report denial trends to management, notating on guarantor/patient accounts of research and resolution of claim(s), resolve insurance and patient credits, answer and resolve account inquiries, and handle secondary insurance claims process.
KEY RESPONSIBILITIES & DUTIES:
KNOWLEDGE, SKILLS, AND ABILITIES
CREDENTIALS/EDUCATION/EXPERIENCE
#ZR
