Revenue Cycle Associate - Claims & Denials

Mecklenburg EMS Careers•Charlotte, NC

2d•Hybrid

About The Position

This is a hybrid position located in Charlotte, NC. Candidates must live in Charlotte or within a commutable distance and be available to work onsite as required. The role involves applying in-depth knowledge of medical claims denial and insurance follow-up to independently review accounts and take action for proper adjudication and payment. Responsibilities include managing incoming correspondence from payors, preparing and submitting payor appeals with supporting documentation, utilizing external payor portals, and contacting insurance payors to obtain claim status updates. The associate will interpret claim edits, rejections, and coverage guidelines, update patient accounting systems, analyze denial trends, and manage work queues to meet productivity and quality standards. Maintaining up-to-date knowledge of various insurance billing practices and ambulance medical billing requirements is crucial. The role also involves writing and filing detailed appeals, reviewing insurance claim forms, remittances, and correspondence, and demonstrating strong analytical and critical thinking skills. Staying current on ambulance coding, regulatory billing guidelines, and insurance law changes is essential. Maintaining confidentiality and complying with HIPAA and other regulations is required. Collaboration with cross-functional teams, providing quality customer service to patients, and proficiency in billing software are key. Flexibility to support other revenue cycle functions and maintain positive working relationships are also important.

Requirements

Experience in the healthcare revenue cycle process
Experience working insurance denials and appeals
Familiarity with payer portals and clearinghouses
Excellent verbal communication skills
Demonstrated ability in the use of Microsoft products
Ability to perceive and distinguish emotions during interactions with people via telephone and respond courteously
Maintain acceptable attendance and adhere to scheduled work hours
Ability to work within a team-oriented, fast-paced, customer focused environment
HS diploma/GED required

Nice To Haves

Associate degree preferred
Certified Ambulance Coder (initial certification only) preferred

Responsibilities

Apply in-depth knowledge of medical claims denial and insurance follow-up to independently review accounts and take action for proper adjudication and payment.
Manage incoming correspondence from payors and respond timely to ensure claims are processed and resolved efficiently.
Prepare and submit payor appeals with supporting documentation; utilize external payor portals for claims management, follow-up, and appeal submission.
Contact insurance payors via phone or electronic means to obtain claim status updates and pursue resolution.
Interpret claim edits, rejections, and coverage guidelines to identify appropriate solutions and minimize delays in reimbursement.
Accurately update patient accounting systems with correct demographic and insurance data, documenting all actions taken on accounts.
Analyze denial trends, identify root causes, and assess the impact on accounts receivable; recommend or initiate corrective action as needed.
Manage assigned work queues efficiently to meet established productivity and quality standards, preventing timely filing denials.
Maintain up-to-date knowledge of Medicare, Medicaid, Medicare Advantage, Managed Care, and Commercial insurance billing practices, including fee schedules and consolidated billing.
Apply understanding of ambulance medical billing, documentation requirements (e.g., PCS forms, transfer of care, certification levels), and compliance with federal and state coding guidelines.
Write and file detailed appeals with insurance carriers, using clinical coverage policies and payer-specific documentation requirements.
Review insurance claim forms, remittances, and correspondence to ensure accurate payment and resolve claim denials.
Demonstrate strong analytical and critical thinking skills to apply payer-specific coverage policies effectively.
Stay current on ambulance coding, regulatory billing guidelines, and changes in insurance laws and reimbursement policies.
Maintain confidentiality and comply with all HIPAA and privacy standards, federal and state regulations, and the agency’s compliance program.
Collaborate cross-functionally and continuously seek ways to improve workflow, customer service, and internal operations.
Provide quality customer service to patients, including verifying insurance, responding to inquiries, resolving account issues, and ensuring timely follow-up.
Proficiently use billing software, clearinghouses, and relevant tools for electronic claim submission and account management.
Demonstrate flexibility by supporting other revenue cycle functions when needed, such as registration, coding, cash posting, and payment posting.
Maintain positive working relationships with internal departments, external payors, and the general public.