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Medical Billing
1 month ago
More Information about this Job:
Medical Billing-Revenue Cycle Appeal Determination Medicaid/TPL
The Appeal Determination Medicaid/TPL position is responsible for reviewing incorrectly processed and/or denied claims to determine next appropriate actions to resolve the claim.
Essential Functions/Duties
Effectively process remittance advice notices from Medicaid and TPL (primary, secondary, tertiary) to determine next actions.
Obtain and document necessary reprocessing and/or appeal related data to resolve the incorrectly processed/denied claim in a timely and efficient manner.
Assure process and resources are allocated to provide required payor documentation assembly and filing in a timely manner.
Analyze work processes to maximize efficiency.
Work to achieve team and departmental goals.
Work effectively as a member of a team.
Communicate clearly and concisely, both orally and in writing.
Qualifications:
Required Experience
Must be fluent in English
Minimum three (3) years experience in healthcare/revenue cycle billing environment
Above average knowledge of Medicaid, Medicaid Replacement and Third-Party Liability billing guidelines
Ability to read and decipher an explanation of benefits and/or remittance advice notice
Minimum of one (1) year working in a call center environment
Ability to work independently or as an active member of a team
Must possess empathic and professional written and verbal communication skills
Knowledge and experience of computers and related technology, at an intermediate level
Preferred Experience
A minimum of one (1) year working in a customer service
Education
High school diploma or equivalent
Skills:
Knowledge of health care billing procedures, reimbursement, third party payer regulations, documentation, and standards
Knowledge of health care billing compliance regulations
Knowledge and understanding of payor Explanation of Benefits (EOB)/ Remittance Advice (RA) notice
Requires strong problem-solving skills, attention to detail, and ability to make timely decisions
Intermediate computer skills and familiarity with Microsoft Office, especially Excel
Ability to adapt to change
Above average internal and external customer service skills
Responsiveness and a strong commitment to meeting internal and external deadlines with limited supervision
Above quantitative, analytical, and problem-solving skill
Why Choose Air Evac Lifeteam? As a leader in helicopter air ambulance services, Air Evac Lifeteam is one of Global Medical Response's (GMR) family of solutions. Our GMR teams deliver compassionate, quality medical care, primarily in the areas of emergency and patient relocation services. View the stories on how our employees provide care to the world at www.AtaMomentsNotice.com.. Learn how our values are at the core of our services and vital to how we approach care and check out our comprehensive benefit options at GlobalMedicalResponse.com/Careers.
EEO Statement:Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.
