RCM - Specialty Follow Up- Hiring Immediately!

Company: -
Location: Lawton
Posted on: November 22, 2021

Job Description:

We've learned that what is best for patients is also best for employees. Learn more about why we are one of the Best Companies to Work for in Texas--.________________________________________________________________ Job Summary: The Revenue Cycle Management Specialty Follow Up position is responsible for ensuring accurate and timely submission of insurance claims, obtaining missing information, researching denials and documentation, following up on claims, and maintaining compliance with department standards, HIPAA, and governing agency policies and procedures. This position also ensures all initial third party and federal/state government claims are billed and all unpaid, rejected or denied claims receive appropriate follow up or an appeal to over-turn the denial as required. Accurately and timely preparation and submittal of corrected claims to payers via electronic (837) or paper is also required. The RCM Specialty Follow up position must take action required to resolve rejected, underpaid and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters. They must also identify and resolve complex claims issues adversely impacting the revenue cycle and achieve resolution through coordination with clinical departments and the payer. This position works closely with the Central Billing Office Administration, clinical practice mangers, billers, and coders. Essential Functions: --- Review, research and resolve coding denials for complex diagnostic studies, endoscopic, interventional and/or major surgical procedures; this includes denials related to the billed CPT, diagnosis, and modifier --- Identification of denial, payment, and coding trends in an effort to decrease denials, improve denial prevention, and maximize collections --- Contact payers via website, phone and/or correspondence, regarding reimbursement of claims denied --- Interpret medical policies and/or Medicare and Medicaid rules and regulations to ensure proper reimbursement/collection --- Prepare and submit claims appeals, based on payor guidelines Additional Responsibilities: Additional duties as assigned Skills and Abilities: --- Requires knowledge of carrier specific claims appeal guidelines to includes claim logic, internet, and paper/fax processes --- Requires proven analytical and decision making to determine what selective clinical information must be submitted to properly appeal the denial ---Requires proven knowledge of CPT and ICD-10 coverage policies, internal revenue cycle coding processes and the billing practices of the specialty service line --- Requires clear and concise written and oral communication with payors, providers, and billing staff to ensure resolution of denials --- Requires the ability to read and interpret E&M notes, complex diagnostic study results, endoscopic and interventional results and/or major surgical operative notes. --- Determine appropriate action for denial resolution based on documentation --- Requires proven knowledge of the specialty specific service line documentation requirements. Minimum Qualifications: --- High School diploma or equivalent --- CPC or CPC-A required or may be contingent on completing AND passing the CPC exam within six (6) months of hire date --- Four (4) years medical billing or collections required (combination of higher education and experience may be considered to satisfy years of experience requirement) --- Medical terminology --- Type 40wpm, 10 key by touch --- Strong analytical and critical thinking Preferred qualifications: --- Associates degree --- Knowledge of Medicare, Medicaid, and Commercial Insurance procedures --- Denial management, billing/coding guidelines --- Experience in Cardiothoracic, Gastrointestinal, Neurology, Anesthesiology, or Allergy specialties. Environmental Conditions: Works in well-lighted, heated and ventilated building. Exposure to blood borne pathogens are of low risk. Hours of duty may be irregular. Physical Requirements: Requires prolonged sitting, some bending, lifting, stooping, and stretching. Hand-eye coordination and manual dexterity sufficient to operate a keyboard, copier, telephone, adding machine, fax machine, printers and other minor office equipment is a must. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Must also be able to communicate in person, via voicemail, vie email and on the telephone. Limitations and disclaimer: The above job description is meant to describe the general nature of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. This position is security sensitive UMC Health System--provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of--race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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