East Hartford, CT30+ days ago
Identifies root causes of insurance denials ā¢ Remains current with core knowledge of specific payer policies, contracts, and administrative bulletins ā¢ Communicates identified payer trends such as denials for specific procedure, diagnosis codes, or other identified issues ā¢ Accurately and compliantly resolves insurance balances after payment or adjudication, and correctly identifies any patient liability ā¢ Ensures accurate resolution of account to payment or payor terms ā¢ Follows up with payors to ensure timely resolution of all outstanding claims, via phone, emails, fax, or websites ā¢ Leverages available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolution ā¢ Documents all activity in accordance with organization and payor policies ā¢ Coordinates appeal when claim is denied ā¢ May partner with medical care team members on complex appeals ā¢ Submits LOMN (Letter of Medical Necessity) and other drafted appeals and reconsiderations on rejected and denied claims ā¢ Sends appeals to payors and follows up to ensure payment is made ā¢ Continues to review account and escalates as necessary if denial is not overturned ā¢ Engages the CFC, UR, Revenue integrity, or coding follow-up team for any medical necessity, auth, or coding related to denials review ā¢ Sets follow-up activities based on status of the claim; ensures full and clear account documentation on account status within system ā¢ Collaborates as a part of a team on special projects by utilizing Excel spreadsheets and effectively communicates results ā¢ Performs other job-related duties as assigned. Experience: Minimum of 3 years Billing experience required in healthcare Rev Cycle with specialization in billing, account receivable follow-up, and denial management, with a High School Diploma/GED OR Minimum of 2 years direct experience with an Associate or Bachelors degree.