Account Review Specialist

1 week ago

Coldwater, Ohio, United States Medix Full time

This role involves thorough and accurate analysis of denied accounts to ensure timely reprocessing and payment. Key responsibilities include following up with insurance companies, reconciling accounts, filing corrected claims, appealing denials when necessary, and investigating payor rejections.

Essential Functions and Responsibilities
  • Understand and adhere to WPH Performance Standards, Policies, and Behaviors.
  • Process rejections, denials, and other correspondence from third-party payers.
  • Resolve non-payment issues to ensure accurate rebilling, when needed.
  • Navigate WPH payor contracts for accurate information to determine non-payment issues.
  • Facilitate necessary actions internally using EMR to ensure claims move through the system accordingly.
  • Discuss denial issues with payor representatives to advocate for prompt payment.
  • Report trends and claim issues to leadership to prevent future issues.
  • Have a strong understanding of codes, billing rules, and regulations.
  • Responsible for submitting appeals to third-party payers to recover additional revenue.
  • Investigate payer rejections and denials to identify root causes.
  • Analyze and decipher all denials, including duplicate claims, timely filing, EOB requests, and not medically necessary claims.
  • Review and trend denial issues to identify patterns and bring accounts to final resolution.
  • Communicate effectively with leadership and document recommendations for process improvements.
Education and Experience Requirements
  • A high school diploma or equivalent is required.
  • Prior experience in a hospital setting, specifically in billing, follow-up, and denials, is preferred.
  • Knowledge of medical terminology is also preferred.
  • Familiarity with electronic medical record systems, particularly EPIC, is beneficial.
  • The ability to multitask, problem-solve, and perform various duties on demand is essential.
  • Proficiency in Microsoft Office and Excel, including reporting capabilities, is necessary.
Salary

$54,000 - $62,000 per year, based on experience.

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