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Ar Denials Specialist
5 months ago
Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites.
- Collect payments for outstanding claims and ensure payments received are reconciled correctly.
- Utilizes contract management system to obtain the claim expected reimbursement information to ensure claims are paid correctly. Follows department’s process for follow up on underpayments/overpayments.
- Research and prepare responses for payor requests for additional information or documentation.
- Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
- Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial.
- Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines.
- Responsible for adequately working correspondence timely and efficiently (including EOBs, RA’s, denial letters).
- Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry.
- Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary.
- Identify complex and aged claims issues and follows internal escalation process appropriately.
- Maintain patient confidentiality and privacy; adheres to HIPAA standards.
- Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.
- Must meet department Productivity Guidelines. Works with all areas of the department to assure maximum productivity. Utilizes the PFS Productivity tracker.
- Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
- Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.
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