Billing/Collections Specialist
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Core Responsibilities :
- Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
- Independently write professional appeal letters.
- Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as WCR policies and procedures.
- Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
- Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and / or root cause resolution.
- Make recommendations for additions / revisions / deletions to claim edits to improve efficiency and reduce denials.
- Identify opportunities for process improvement and actively participate in process improvement initiatives.
Customer Service Standards :
- Support co-workers and engage in positive interactions.
- Communicate professionally and timely with internal and external customers.
- Ability to stay calm under pressure and deal effectively with insurance company associates
Billing/Collections Specialist
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