Insurance Accounts Research Specialist - TMG Billing (Days)

Tanner Health System-posted 3 months ago
Full-time
Carrollton, GA
1,001-5,000 employees
Religious, Grantmaking, Civic, Professional, and Similar Organizations
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Responsible for day to day follow-up of Medicare, Medicare Advantage plans, Medicaid, CMOs, and commercial insurance claims, and the review of aging reports to identify and resolve problem areas. Also includes the working of all rejections and denials accurately and efficiently. Necessary to prioritize work, formulate a plan of action, and analyze results, as well as communicate trends and billing coding issues.

  • Analyzes and resubmits rejections, denials, and all levels of appeals for the purpose of identifying problems and recommending solutions to problems which cause delays in claim processing.
  • Provides comprehensive analysis and follow-up to all accounts of patients associated with Medicare, Medicare Advantage plans, Medicaid and CMOs, and commercial insurance.
  • Provides high quality services to all customers, including patients, physicians, physician practice employees, coworkers, and insurance companies.
  • Sends written refund request to manager for approval and completes the refund spreadsheet for Accounting.
  • Works accounts receivable according to CBO protocol and does not work denials prior to posting of the denials by the Cash Posters.
  • Analyzes individual accounts and develops a follow-up and collections strategy that results in payment in the shortest time possible.
  • Analyzes work on hand on a daily basis and determines how to allocate manpower to achieve the greatest benefit.
  • Assists the payment processing team with posting checks at the end of the month.
  • Assists with special projects and account analysis procedures when asked.
  • Assures that payers are provided with necessary information and documentation immediately upon request.
  • Develops and maintains a high level of expertise in the unique requirements of individual payer and Health West PHO managed plans.
  • Maintains good relationships with physician practices for the purpose of resolving billing problems.
  • Negotiates with insurance companies when refund requests are considered to be inappropriate or original reimbursement is questionable.
  • Participates in educational activities and attends monthly staff meetings.
  • Prepares monthly performance reports to indicate the impact of work done rather than the volume of work done.
  • Provides customer service functions to include addressing patient inquiries and complaints from all sources in a timely manner.
  • Remains alert for process improvements and recommends changes when beneficial.
  • Responsible for determining whether commercial credit balances should be refunded to the insurance company.
  • Responsible for notifying CBO management of any payer changes that need to be updated with the Practice Management software.
  • High School Diploma or GED.
  • Two years of related experience.
  • Working knowledge of specialized practices, equipment, and procedures.
  • Ability to meticulously organize, analyze, and prioritize workload.
  • Ability to communicate issues to CBO management and offer a resolution.
  • Ability to work professionally and closely with others, and function as a team member.
  • Exhibit exceptional communication skills verbally and in writing.
  • Minimum of two years experience in insurance and patient billing, and AR, which includes credits, refunds, offsets, and posting payments.
  • Possess a comprehension of working and analyzing AR to resolve claim denials timely.
  • Working knowledge of CPT & ICD Coding, and medical terminology required.
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