Payment Recovery Specialist - Out of State Billing (Medicaid) - Fully Remote!
Centauri Health Solutions, IncArizona, US
30+ days ago
Job type
Remote
Job description
Role Summary :
The Payment Recovery Specialist reviews claims to make sure that payer specific billing requirements are met, follows-up on billing through payment of the claim, answers inquiries, and updates accounts as necessary. The Payment Recovery Specialist is responsible for analysis of denied reimbursement claims and ensures appropriate insurance coverage for compliance standards and revenue generation. The Payment Recovery Specialist coordinates with departments and insurance companies to correct errors as necessary.
Role Responsibilities :
Resolves billed claims and referred denials
Runs reports to determine upcoming workload
Performs initial contact (phone, web portal) with payers to validate claim status and reason for denial.
Extracts data from client patient accounting system necessary to resolve denied claims
Documents account activity in both the Human Arc and client operating system (posts, dispos, notes, status, etc.)
Sorts through and takes appropriate action on incoming client correspondence from insurance companies
Requests and obtains medical records from client or other documentation from physicians offices to resolve denied claims
Requests additional information as needed from clients, physicians and / or related providers and patients to resolve denied claims
Issues appeal letters on non-clinical denials
Follows up with patient for additional information
Follows up on all appeals, payments and denials, bringing accounts to resolution with both payer and client
Communicates pertinent client and payer trends to the Team Leader
Review payment accuracy for final disposition of account
Performs filing / scanning as needed on assigned accounts
Communicates pertinent client information regarding procedures, project status to Team Leader
Accountable for meeting established productivity measures and goals
Participates in special projects as assigned
Role Requirements :
Knowledge of and experience with Hospital Patient Accounting systems; language, flow of work, processes, and procedures
Strong knowledge of insurance types and associated administrative guidelines for each
Understanding of hospital revenue cycle and insurance payment methodologies
Billing process and procedures (including parameters and requirements of billing)
Electronic billing software
Understanding of insurance contracts and terminology
Knowledge of State policies / procedures on determining eligibility and claims processing
Basic understanding of appeals / denial resolution processing needs
Strong communication skills and problem-solving ability
Strong analytical, project planning and organizational skills