Central Denials Account Representative - Full Time, Days, Onsite

Guidehouse•Birmingham, AL

1d•Onsite

About The Position

The Central Denials Account Representative conducts thorough account reviews to determine the appropriate action needed to resolve the account balance. This includes reviewing and performing the following: 227 Electronic Files 835 Electronic Files UB04’s and 1500 Claim Files Medical Records Making outbound calls to insurance companies to resolve claim denials and account balances. Performing Non-Clinical Appeals. Assisting Supervisor/Manager as needed with various projects. Escalate payer issues/trends to a supervisor with the appropriate information or take appropriate action so that the issue expert can effectively resolve the matter. Communicate to Supervisor/Manager areas of concern or areas of improvement. Resubmit Corrected Claims and supporting documentation as need for the patient experience. Communicate with other organizational departments to ensure proper handling of patient accounts. Communicates issues to management timely and performs other duties as assigned by direct supervisors. Perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure.

Requirements

HS Diploma or equivalent.
0-2 of prior relevant experience

Nice To Haves

Two years medical provider experience working with UB04, appeals & denials.
Ability to perform essential job functions with high degree of independence, flexibility, and creative problem-solving techniques.
Ability to interpret and apply reimbursement aspects of managed healthcare contracts.
Exceptional customer service skills including effective and efficient problem solving and analyzing skills.
Ability to initiate and follow through on projects and work independently with minimal supervision

Responsibilities

Conducts thorough account reviews to determine the appropriate action needed to resolve the account balance.
Reviews and performs: 227 Electronic Files, 835 Electronic Files, UB04’s and 1500 Claim Files, Medical Records
Makes outbound calls to insurance companies to resolve claim denials and account balances.
Performs Non-Clinical Appeals.
Assists Supervisor/Manager as needed with various projects.
Escalates payer issues/trends to a supervisor with the appropriate information or take appropriate action so that the issue expert can effectively resolve the matter.
Communicates to Supervisor/Manager areas of concern or areas of improvement.
Resubmits Corrected Claims and supporting documentation as need for the patient experience.
Communicates with other organizational departments to ensure proper handling of patient accounts.
Communicates issues to management timely and performs other duties as assigned by direct supervisors.
Performs a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure.

Benefits

Medical, Rx, Dental & Vision Insurance
Personal and Family Sick Time & Company Paid Holidays
Position may be eligible for a discretionary variable incentive bonus
Parental Leave
401(k) Retirement Plan
Basic Life & Supplemental Life
Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts
Short-Term & Long-Term Disability
Tuition Reimbursement, Personal Development & Learning Opportunities
Skills Development & Certifications
Employee Referral Program
Corporate Sponsored Events & Community Outreach
Emergency Back-Up Childcare Program