Job Details

Claim Edits and Insurance Denials Specialist

This position is a work from home position

Flexible Schedule - Monday - Friday: 6:00AM - 6:00PM

Claim Edits

• Responsible for researching patient billing claims to identify and correct coding/claim errors
• Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage denials.
• Research and outline documentation needed for respective payor organizations so that claims are processed correctly
• Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc.
• Identify problem trends
• Communicate with payors for resolution to complications with claims
• Responsible for 277 EDI transactions/rejections
• Working with EDI transactions
• Payment posting corrections/adjustments and ability to distribute payments
• Correct/enter charges
• Work with multiple teams/departments to resolve issues
• Payment plan or financial assistance coordination

Insurance Denials and Follow-Up

• Responsible for researching, identifying errors, and correcting claims denied by insurance companies.
• Must be able to assess claim to determine when appropriate to make charge adjustments, void a charge, or escalate to the team lead and/or another medical billing team.
• Responsible for writing appeal letters to insurance companies
• Responsible for following up with insurance companies for no response claims.
• Responsible for working with patient calls escalated from the Customer Service team regarding involving billing code issues.
• Research refund request from payor organizations
• Responsible for preliminary audit of billing code errors before claim submitted to the Coding team.
• Responsible for routing complex claim denial to team lead and/or the appropriate medical billing team.
• Responsible for identifying issues which can be resolved by programming software to prevent denials.
• Responsible for becoming a subject matter expert on the payor policies.
• Responsible for communicating and resolving problems with the provider representatives
• Responsible for simple level coding, including diagnosis review, modifier applications, some CPT cod changes following process documents and payor policies

Candidate must live in or around the Kansas City metropolitan area.

Job Requirements

• 2 years
• Diploma

Full Time Day (United States of America)