Revenue Cycle Associate - Claims & Denials

Mecklenburg EMS Careers•Charlotte, NC

7d•$23

About The Position

DUTIES & 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 EDUCATION/EXPERIENCE: 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; Associate degree preferred CERTIFICATIONS/LICENSES/REGISTRATIONS: Certified Ambulance Coder (initial certification only) preferred Individuals must not be excluded from filing claims to any federal or state government payor. SALARY RANGE: Starting pay= $23.23/hr; additional based on experience. Interested applicants must complete the online application and upload a resume to be considered for the position. Applications will be accepted until the position is filled. If you have any further questions, please contact MEDIC Recruitment at [email protected].

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
Individuals must not be excluded from filing claims to any federal or state government payor.

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