As a key member of the post service denials team, the Denials PAR will:

• Expedite and maximize payment of insurance medical claims by contacting third-party payors and patients including resubmission of claims, corrected claims, appeals, etc.
• Complete post service denial tasks in accordance with established productivity and performance standards.
• Collaborate with management in developing a plan to reduce aging of accounts with efficiency and maximum results.
• Effectively communicate and collaborate with management to determine escalation of denied claims.
• Identify claims processing issues upstream for denial prevention.
• Demonstrate the expertise of all payors, including Medicare, Medicaid, and commercial payors.
• Assist with knowledge sharing, payor, and department training, and provide support to other team members as advised by the manager and/or supervisor.
• Identify, analyze, and escalate trends impacting AR collections.
• Execute special projects to improve AR performance, as assigned

EDUCATION AND EXPERIENCE

• Three years physician billing experience, preferably in a large orthopedic physician practice.
• Knowledge of EMR (Electronic Medical Record) (athenahealth preferred).

SKILLS/ABILITIES

• Ability to critically think through next steps on at risk accounts and resolve with optimal outcome.
• Ability to prioritize workload for maximum benefit on aging accounts and to ensure that accounts do not age out beyond timely filing limits.
• An ability to identify upstream blockers, prioritize solutions and communicate effectively.
• Excellent communication and influencing skills; proven experience of influencing other teams/groups where their support is critical to success.
• Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development.
• In-depth knowledge of CPT-4, ICD-10 and HCPCS coding, along with CCI edits.
• Must have a comprehensive understanding of insurance pre-certification requirements, contract benefits, and medical terminology.
• Managed care knowledge with the ability to differentiate between insurance plans such as Preferred Provider Organization (PPO), Point of Service (POS), Health Maintenance Organization (HMO), etc.
• Actively engages in personal assessment and expands learning beyond baseline competencies with a focus on continual development.
• Ability to effectively communicate with physicians, clinic staff, patients, and co-workers consistent with a customer service focus and application of positive language principles.
• In depth knowledge of third-party payer reimbursement policies and procedures