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Revenue Cycle Specialist

2 months ago

Roseville, Michigan, United States HarmonyCares Full time
Job Summary

We are seeking a highly skilled Denial Management Specialist Lead to join our team at HarmonyCares. As a key member of our Revenue Cycle Management department, you will be responsible for ensuring optimal payment of claims for our patients.

Key Responsibilities
  • Lead the team in resolving claims issues and ensuring maximum reimbursement
  • Collaborate with other departments to resolve reimbursement challenges
  • Assist in training and onboarding new hires
  • Develop and maintain Standard Operating Procedures
  • Review and analyze insurance claims and encounters for root cause denial reasons
  • Access denied claims and query claim status with payors
  • Resolve denial trending and communicate trends to management
  • Assist the team in prioritizing claims based on aging and outstanding dollar amounts
  • Learn and understand internal and external operating systems
Requirements
  • 5+ years of insurance follow-up experience in a healthcare insurance environment
  • Computer experience with Microsoft products, including Excel, Pivot Tables, and SharePoint
  • Ability to use critical thinking skills for troubleshooting staff questions/issues
  • Knowledge of multi-specialty physician billing procedure guidelines and basic understanding of medical terminology, ICD and CPT codes
  • Knowledge of value-based care model
  • Experience in filing claim appeals with different payers
  • Ability to perform mathematical computations and define problems, collect data, and interpret billing information
Preferred Qualifications
  • Associates degree
  • Certification in Medical Billing/Coding
  • Certified Revenue Cycle Representative (CRCR)
What We Offer
  • Competitive salary range: $25.68 - $31.18 per year
  • Individual compensation packages based on skill set, experience, qualifications, and other job-related considerations