Wound Care Specialist

15 hours ago

North Richland Hills, Texas, United States R3 Wound Care & Hyperbarics Full time
About R3 Wound Care & Hyperbarics

R3 Wound Care & Hyperbarics is a pioneering healthcare provider dedicated to delivering exceptional patient-centric services across the Dallas Fort Worth metroplex, Houston, and San Antonio. Our organization is poised for growth, focusing on enhancing our clinical delivery model and platform to expand our business and clinic footprint. Our culture is built on teamwork, with each employee willing to contribute to ensure our patients receive the highest quality care and comfort.

R3 Benefits

Our team members enjoy a sense of fulfillment knowing they make a difference in patients' lives. They also receive competitive compensation, attainable monthly incentives, and a comprehensive benefits package, including PTO, holiday, bereavement, and maternity leaves; 401k; company-sponsored health and dental insurances; a range of voluntary benefits; continuous clinical training; and professional development led by our Chief Medical Officer.

Job Summary & Qualifications

This role focuses on producing high-quality work based on established standards, guidelines, and procedures related to billing, collections, and the revenue cycle department. The successful candidate will demonstrate precision, consistency, and patience, handling and completing tasks efficiently. Job knowledge and competency will be built through structured training and positive coaching from management and peers. Knowledge of third-party commercial and governmental payers, and their relationships with providers and patients, is crucial for success in this role. Effective communication with others will be based on knowledge of repetitive job routines and procedures gained from sufficient on-the-job experience.

Duties & Responsibilities
  • Make outbound calls to payors regarding claims status.
  • Communicate with patients regarding account status.
  • Experience with Health Fusion or Wound Expert systems.
  • Review medical records and accounts as needed.
  • Accurately document all calls made or received.
  • Responsible for scanning, faxing, and emailing documents as needed.
  • Communicate with coworkers regarding claims/denials updates and concerns.
  • Understand and follow proper medical claims collection Company Standard Operating Procedures.
  • Comply with all patient privacy and HIPAA rules.
  • Ensure proper reimbursement of paid claims.
  • Prepare reconsideration or appeal letters to payors when required.
  • Understand managed care authorizations and limits to coverage.
  • Be able to read and understand patient insurance verifications, payor policies, signed agreements on file, payor EOBs, and correspondence.
  • Ability to look up and understand ICD10 diagnosis and CPT treatment codes.
  • Knowledgeable about the insurance and reimbursement process.
Requirements
  • Must have a professional and positive demeanor.
  • Medical coding certification is preferred.
  • Must have 3 years of medical collections experience required.
  • Self-starter who works well independently and as a member of a team.
  • Must be proficient in organization and multitasking.
  • Must be proficient with Outlook, Word, Excel, Payor portals, and referencing payor policies.

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