group
Category
Administrative Support
business
Department
Clinic Billing Services
date_range
Schedule
Full Time
schedule
Shift
Day
timer
Hours
8 Hour Shift
place
Location
Rancho Mirage, CA
info
Job #
R0251986




  • Job Objective: A brief overview of the position.



    • Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports .Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements. Works with the coding team and Provider Liaisons to provide information to Physicians and Extenders related to denials and opportunities to reduce same.


  • Reports to



    • Director Clinic Billing Services


  • Supervises



    • None


  • Ages of Patients



    • N/A


  • Blood Borne Pathogens



    • Minimal/ No Potential


  • Qualifications



    • Education



      • Required: High School diploma or equivalent


      • Preferred: Associate degree


    • Licensure/Certification



      • Preferred: Certified coder or currently enrolled in a coding program


    • Experience



      • Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.


      • Preferred: three to five years of Patient Accounting in a high volume environment.


  • Essential Responsibilities



    • Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations


    • Analyze denied, underpaid and unpaid claims. Appeal underpaid and denied claims within timely filing periods


    • Identify, track and report on denial trends


    • Maintain an appeals data base to identify and report outcomes and opportunities


    • Identify any coding trends resulting in denials and report to the Coding manager


    • Identify any other trends resulting in denials and report to Clinic PFS Director


    • Attend all available coding and appeals related seminars as available

    • All other duties as assigned

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