Senior Representative

2 weeks ago

Akron OH, United States TeamHealth Full time

TeamHealth is named among the "150 Great Places to Work in Healthcare" by Becker's Hospital Review and has ranked three years running as "The World's Most Admired Companies" by FORTUNE Magazine as well as one of America's 100 Must Trustworthy Companies by Forbes Magazine in past years. TeamHealth, an established healthcare organizations is physician-led and patient-focused. We continue to grow across the U.S. from our Clinicians to our Corporate Employees and we want you to join us.


~ Career Growth Opportunities
~ Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
~401K program (Discretionary matching funds available)
~ GENEROUS Personal time off
~ Eight Paid Holidays per year
~ Quarterly incentive plans

*This is a remote-based, work-from-home position*



JOB DESCRIPTION OVERVIEW:


The Provider Enrollment Research Representative will review, organize, and verify all denials, pertaining to provider's enrollment. The Provider Enrollment Research Representative will communicate the necessary action to correct/resolve the provider denial for payment.



ESSENTIAL DUTIES AND RESPONSIBILITIES:


Monitor and review all payment denials as assigned in ETM (Enterprise Task Manager)
Utilize the telephone and various carrier websites as research tools to expedite resolution for issues
Assembles and forwards documentation to appeal disputed claims
Contacts carriers to inquire on claims that have been denied and appealed
Assembles and forwards appropriate documentation to the Senior Analyst for provider related issues
Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting the Akron Billing Center claims
Reports any consistent errors found during claims review that may affect claims from being processed correctly
Consistently meet and maintain the QA (95% or better) and designated production standards
Performs additional duties as directed by the Provider Enrollment Senior/Manager

QUALIFICATIONS / EXPERIENCE:


Thorough knowledge of revenue cycle
Thorough knowledge of healthcare reimbursement guidelines
Computer literate, intermediate knowledge of Excel
Able to work in a fast-paced environment
Good organizational and analytical skill
Ability to work independently
High school diploma or equivalent
One to three years' experience in physician medical billing with emphasis on research and claim denials
General knowledge of ICD and CPT coding

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