Revenue Cycle Specialist II – Appeals and Denials

Senior PsychCare • Houston, TX

2d • $21 - $24 • Onsite

About The Position

Revenue Cycle Specialist II is responsible for processing follow-up actions on claims denied for eligibility-related reasons and responding to health plan correspondence. In this role, you would identify billing issues affecting the provider’s claims and take necessary action to ensure timely and appropriate claim filing. In addition, perform follow-up activities and identify reimbursement issues affecting these claims. The Revenue Cycle Specialist also takes necessary actions to ensure accurate reimbursement and account resolution.

Requirements

• 3+ years of recent Healthcare experience, specifically in claims, Denials, billing, EOB, and insurance verification.
• Minimum 1+ years’ experience in Government Payor follow-up (Required)
• Ability to work independently and prioritize monthly workflow (Required)
• Knowledge of Medical Terminology, CPT Codes, HCPCS, Revenue Codes, Modifiers, and Diagnosis Codes (Required)
• Payer portal and clearinghouse experience (Required)
• Ability to work independently and prioritize monthly workflow (Required)

Nice To Haves

• Mental Health experience (Preferred)

Responsibilities

• Responsible for managing and maintaining a workload of approximately seventy (70) accounts or higher per day to ensure claim(s) resolution.
• Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
• Review and attach appropriate documentation to resolve denied claims and submit appeals.
• Call payers to determine the true reason for denial and inquire about what corrections need to be made.
• Follow up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax, or payer portals.
• Review underpayments and overpayments, work with management to prepare a spreadsheet and summarize findings; escalate as appropriate.
• Prepare and submit denied claims targeted project files to payers, and track reprocessing of project files.
• Identify problematic claim trends and contract violations and report findings to the Manager and Director.
• Contact insurers regarding recoupment payments, double debits, overpaid accounts, and missing checks; initiate dispute process as needed.
• Update insurance information in the system as necessary, initiate and support primary, secondary, and tertiary billing.
• Perform other duties assigned by the Revenue Cycle Manager.

Benefits

• Paid Time Off and Paid Holidays
• Comprehensive benefits packages including Medical, Dental, Vision, 401k, Long Term and Short-Term Disability, Life Insurance
• Healthcare coverage available on the 1st day of the month following full-time employment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed
• Number of Employees: 1-10 employees