Revenue Cycle Associate Ii - Los Angeles, United States - Pediatric Management Group Llc

Description

The position also performs a variety of duties which may include answering incoming telephone calls, documenting insurance information, verification of eligibility, and billing/appealing claims to the various insurance carriers.

This position is responsible for handling patient accounts in a high-performance team environment with a number of additional duties as needed for operational needs.

• Review claims to ensure all key components were submitted accurately to the correct payer.
• Review correspondence and denial information to determine why claims have not been paid and take appropriate actions to ensure the accurate and timely submission of claims.
• Researches and analyzes accounts and payments to determine whether charges were billed properly, and to resolve incorrect information on patient accounts; reverses balance to credit or debit if charges were improperly billed.
• Corrects and resubmits claims and identifies issues that require attention. Makes all the appropriate corrections in the system and submits appeals as appropriate, following individual payer guidelines and including all supporting documentation.
• Contacts insurance companies and or patient/guarantor to verify insurance eligibility and resolve payment problems; provides information to expedite the collection process.
• Prepares adjustments for charges that cannot be billed and processes or submits to the supervisor per adjustment guidelines.
• Ensures authorization, TARs/SARs are included in claim submissions to payers and follows appropriate steps to secure the authorization/retro authorization.
• Ability to assist with special projects as needed.
• Demonstrates the ability to identify trends that may result in system improvement and or special project assignments. The ability to research guidelines for not medically necessary denials.
• Consistently meets productivity and quality standards.
• Assists with training and mentoring new hires or peers.
• Effectively works complex and escalated claims.

• At least three (3) years of healthcare experience in customer service, exposure to payer authorization requirements, insurance verification, or entrylevel collector experience preferred.
• Ability to communicate effectively in both written and verbal formats with internal and external customers.
• Ability to handle multiple tasks simultaneously.
• Familiarity with payer billing and reimbursement guidelines & regulations, including the ability to read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD).
• General ICD.10 knowledge.
• Ability to determine correct claim processing related to payer recoupments, overpayments/credits/refunds & underpayments.
• Ability to organize and manage time effectively.
• Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA & PHI guidelines.
• Ability to work independently and as a part of a larger team.
• Microsoft Word, Outlook & Excel knowledge.
• Highly customercentric position with strong customer service abilities
• Bilingual in Spanish may be required.
• Experience in collections for Behavioral Health preferred, but not required for inpatient and outpatient services.