Medical Billing and Claims Resolution Expert

7 days ago


Memphis, Tennessee, United States University Clinical Health Full time
Job Description

**About University Clinical Health**

University Clinical Health (UCH) is a leading healthcare organization dedicated to providing exceptional medical services to the Mid-South community. As a not-for-profit, non-tax-supported group practice, we are committed to delivering medical excellence while serving the community.

**Job Summary**

This position is responsible for claim resolution of all assigned denial types. The successful candidate will be responsible for identifying and escalating denial trends to the Accounts Receivable Supervisor. This role requires the ability to recognize and communicate with insurance payers for additional review, reconsideration, or appeals.

**Key Responsibilities**

  • Conduct AR Follow-up on denials through best practices, launching appeals as needed via the UCH practice management system.
  • Demonstrate a detailed understanding of how to read and interpret EOB's and denials from all insurance carriers, including financial components such as co-pays, deductibles, and co-insurance.
  • Possess a thorough knowledge of claim resolution from end to end across all payer categories based on insurance denials.
  • Differentiate between best practices of appeal, coding review, credentialing review, and/or adjustment.
  • Contact insurance companies and utilize web portal and websites for appeal, eligibility, remittance, and payment information.
  • Candidate must be able to report and communicate issues and trends.
  • Meet or exceed daily productivity benchmarks.
  • Other assigned duties/tasks

**Requirements**

  • Complete understanding of follow-up processes.
  • Solid background in Accounts Receivable and overall Revenue Cycle policies and procedures.
  • Experience working in a physician billing environment.
  • Excellent communications skills.
  • Excellent systems experience and acuity (EMR and Billing and Collection Systems). Multi-system and multi-specialty experience is preferred.
  • Proficiency in Microsoft Office Suite, including Word and Excel.
  • Ability to communicate orally and in writing in a clear and straightforward manner.
  • Ability to communicate effectively with senior leadership and company personnel.
  • Ability to make decisions and solve problems while working under pressure.
  • Ability to prioritize and organize effectively.
  • Ability to show judgment and initiative and to accomplish job duties.
  • Ability to work independently.
  • Strong business acumen.
  • Strong communication skills, including public speaking.

**Education & Experience**

  • High school diploma or equivalent required.
  • 3+ years of experience in claims resolution or medical billing.
  • Formal certification in medical billing and coding or have equivalent experience.
  • Working knowledge of CPT, ICD-10, and medical terminology.


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