Provider Enrollment Research Representative

4 weeks ago

Akron, 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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