Medical Claims Specialist- Trainer

3 weeks ago

Plano, United States ERISA Recovery Full time
Job DescriptionJob Description

Overview

ERISA Recovery, a frontrunner in the Federal ERISA appeals process for collecting complex and aged claims, seeks a proactive Denied Claims Trainer who specializes in overturning denied claims. You will develop, implement, and facilitate a claims training program with an emphasis on appeals and denials. We are looking for a candidate with in-depth knowledge in the insurance industry and a proven ability to train employees in a fast paced environment. This role is key to securing reimbursement and minimizing organizational write offs.

Key Responsibilities

  • Track Denial Trend: Track denial trends and recovery strategies and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts.
  • Team Coaching and Standards Compliance: Provide ongoing coaching and training to ensure team adherence to standards, regulations, and best practices.
  • Train new employees: teach strategies for prioritizing cases, reviewing account history, remit, and payer history  to determine the appropriate challenge and appeal strategy.
  • Collaborative Teamwork Enhancement: Foster collaboration with back-office and other departmental teams for a unified approach to meeting organizational objectives.
  • Billing and Coding Understanding: Knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes
  • Revenue Cycle: Complete understanding of the revenue cycle process to include prior authorization, billing, insurance appeals, and hospital collections
  • ERISA Federal Guidelines: Interpret and apply ERISA guidelines to determine claim eligibility and benefits.
  • Subject Matter Expert: Maintains working knowledge of applicable insurance carriers’ timely filing deadlines, claims submission processes, and appeal processes and escalates timely filing requests to Leadership.
  • Apply prior knowledge of denials to assess and ensure services/items billed are reasonable and necessary, and supported by Self-funded medical policies
  • Report Findings: Assist department leadership with research, analysis and special projects. Attends necessary payer meetings to escalate denials issues. Participate in huddle meetings and sharing the details of cases worked

Essential Skills & Qualifications

  • Bachelor's Degree preferred
  • Expertise in data analysis for performance management and operational enhancement.
  • Exceptional leadership, team management, and interpersonal communication skills.
  • Detail-oriented with the capability to oversee multiple projects and issues simultaneously, ensuring accurate and timely completion.
  • Proficient in MS Office suites, Electronic Health Record systems, and Insurance Claims Portals.
  • A comprehensive understanding of hospital claims denials, medical terminology, CPT codes, modifiers, diagnosis codes, and payor contracts.
  • In-depth knowledge of collection laws and regulations, as well as understanding of financial principles related to hospital appeals.

Please note: Only applicants with vast knowledge of hospitals claims denials need apply.

ERISA Recovery believes in a work-life balance and offers a competitive compensation package including a flexible work schedule, 401k, bonus plan and medical and dental benefits.

ERISA Recovery is an Equal Opportunity Employer

Company DescriptionWe are the leader in appeals / collections for hospitals nationwide. Huge growth opportunities for those who are looking to grow and retire with our teamCompany DescriptionWe are the leader in appeals / collections for hospitals nationwide. Huge growth opportunities for those who are looking to grow and retire with our team

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