Medical Claims Examiner- Trainer
3 weeks ago
**ONSITE POSITION**
ERISA Recovery, a frontrunner in the Federal ERISA appeals process for collecting complex and aged claims, seeks a proactive Denied Claims Trainer who specializes in overturning denied claims. You will develop, implement, and facilitate a claims training program with an emphasis on appeals and denials. We are looking for a candidate with in-depth knowledge in the insurance industry and a proven ability to train employees in a fast paced environment. This role is key to securing reimbursement and minimizing organizational write offs.
Key Responsibilities
- Subject Matter Expert: Complete understanding of Surgical Claims, DRG- **Transplant and Cancer claims process is a plus ** Maintains working knowledge of applicable insurance carriers’ timely filing deadlines, claims submission processes, and appeal processes and escalates timely filing requests to Leadership.
- Track Denial Trend: Track denial trends and recovery strategies and appropriately reporting on-going problems specific to payers, health system departments, and/or contracts.
- Team Coaching and Standards Compliance: Provide ongoing coaching and training to ensure team adherence to standards, regulations, and best practices.
- Train new employees: teach strategies for prioritizing cases, reviewing account history, remit, and payer history to determine the appropriate challenge and appeal strategy.
- Collaborative Teamwork Enhancement: Foster collaboration with back-office and other departmental teams for a unified approach to meeting organizational objectives.
- Billing and Coding Understanding: Knowledge of medical terminology, CPT codes, modifiers, and diagnosis codes
- Revenue Cycle: Complete understanding of the revenue cycle process to include prior authorization, billing, insurance appeals, and hospital collections
- ERISA Federal Guidelines: Interpret and apply ERISA guidelines to determine claim eligibility and benefits.
- Apply prior knowledge of denials to assess and ensure services/items billed are reasonable and necessary, and supported by Self-funded medical policies
- Report Findings: Assist department leadership with research, analysis and special projects. Attends necessary payer meetings to escalate denials issues. Participate in huddle meetings and sharing the details of cases worked
Essential Skills & Qualifications
- Bachelor's Degree preferred
- Expertise in data analysis for performance management and operational enhancement.
- Exceptional leadership, team management, and interpersonal communication skills.
- Detail-oriented with the capability to oversee multiple projects and issues simultaneously, ensuring accurate and timely completion.
- Proficient in MS Office suites, Electronic Health Record systems, and Insurance Claims Portals.
- A comprehensive understanding of hospital claims denials, medical terminology, CPT codes, modifiers, diagnosis codes, and payor contracts.
- In-depth knowledge of collection laws and regulations, as well as understanding of financial principles related to hospital appeals.
Please note: Only applicants with vast knowledge of hospitals claims denials need apply.
ERISA Recovery believes in a work-life balance and offers a competitive compensation package including a flexible work schedule, 401k, bonus plan and medical and dental benefits.
ERISA Recovery is an Equal Opportunity Employer
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