Accounts Receivable Specialist (remote)

Cognizant•Earth City, MO

5d•$50,000 - $55,000•Remote

About The Position

In this role the successful candidate performs advanced level work related to resolution of physician claim denials. This position will be responsible for root cause analysis physician payer denials, experience in identifying procedures impacted by National Correct Coding Initiative Edits (NCCI), technical payer policies, appeal documentation and resolution. In addition, this position will be responsible for identification collaboration and implementation of process initiatives to reduce denials

Requirements

Possess basic knowledge of entire RCM process
Recognizes problems or trends and provides suggestions to help find resolutions
Strong knowledge of medical terminology CPT codes modifiers and diagnosis codes and specific carrier requirements knowledge
2 to 3 years' experience working in RCM specifically collections
Ability to follow up on outstanding AR
Ability to review interpret EOBs 835837 and respond using medical guidelines and policies
Prioritize pending claims from aging basket and follow up at regular intervals to collect outstanding
Knowledge in writing appeals and following thru appeals process
Resolve accounts to get paid with max 2 touches
Communicates with leadership regarding specific reimbursement issues
Strong analytical skills and ability to meet assigned deadlines
Exceptional problem solving and critical thinking skills to root cause denials and resolve accounts Must meet quality and productivity standards
Demonstrates knowledge and expertise in state, federal billing guidelines reimbursement methodologies and payer policies
Makes recommendations for additions, revisions, deletions to work queues and claim edits to improve efficiency to reduce denials and underpayments
Exceptional Excel skills to summarize and provide detailed reporting to management and client
Tracks and trends claim denials and underpayments to identify initiatives for payer process or technology improvement plans
Strong communication skills both verbal and written to ensure all actions taken are documented appeal letters are effective, and root cause is communicated

Nice To Haves

Associates or Bachelors preferred or equivalent experience in denial management.
Documented technical skills, Excel, Payer Portals, and Claims Clearinghouses.

Responsibilities

Following up directly with payers to resolve claim issues and secure appropriate and timely reimbursement
Identify and analyze denials and payment variances and take action to resolve account including drafting and submitting technical appeals
Examine denied and underpaid claims to determine the reason for discrepancies
Communicate directly with payers to follow up on outstanding claims file technical appeals resolve payment variances and ensure timely reimbursement
Ability to identify with specific reason underpayments denials and cause of payment delay
Works with management to identify trend and address the root causes of issues in the AR
Maintain a thorough understanding of federal and state regulations as well as payer specific requirements and take appropriate action accordingly
Document activity accurately including contact names addresses phone numbers and other pertinent information
Demonstrate initiative and resourcefulness by making recommendations and communicating trends and issues to management
Needs to be a strong problem solver and critical thinker to resolve accounts
Must meet productivity and quality standards