Payment Research Specialist

Unified Women's Healthcare•UNAVAILABLE, Texas

10d

About The Position

This position is responsible for resolving claims issues within the Care Centers(CCs). The position is responsible for A/R denials, underpayments, payments not according to contractual agreements, and any unresolved claims issues that may arise directly from the Care Center. There is an expectation of consistent communication via telephone and/or email to multiple entities (internally & externally) to resolve these issues.

Requirements

High school diploma or equivalent
Minimum of 5 years’ experience interpreting insurance explanation of benefits, plan benefits, and patient benefits/liability
Minimum of 5 years’ experience working with medical claims (HCFA 1500, UB04, UB92), insurance billing, payment posting, insurance collections, appeals, and medical records requirements/requests
Must possess excellent customer service skills communicating logically and clearly (verbally and in writing)
Experience and knowledge of insurance payer websites (e-appeals & verification of eligibility)
Experience with Microsoft Office & proficiency in data entry
Knowledge of Insurance guidelines and contracting information according to industry standards
Knowledge of governmental insurance especially Medicare and Medicaid according to industry standards

Nice To Haves

Knowledge of Medical Billing & Coding or Certification is a plus

Responsibilities

Processes “Unpostables Dashboard” (i.e., payment or RA missing or not clear) in Athena
Processes “non” claim situations such as recoupment of payment for different CC’s paid claims, incentives, etc.
Record Incentive payments received
BYOLB process “Download Non-Athena Remittance”
Manages Payspan (pulling remits from payer sites)