Key skills
Negotiation
About this role
Role Overview
- Responsible for conducting detailed review of hospital itemized bills for identification of billing and coding opportunities for all payor’s claims
- Prepare and upload documentation clearly identifying findings
- Accurately calculate/verify the value of compliance edits and documentation for claim processing
- Monitor multiple reports to track client specific requirements, turnaround time and overall claims progression
- Complete claims processing after the Clinical Bill Review and Audit analysis is completed
- Adhere to department billing guidelines and documentation
- Maintain audit accuracy and productivity standards per the latest requirements
- Perform regular audits of lower-level team members for quality assurance, providing detailed feedback and education
- Train/Develop new team members utilizing the standard operating procedures and training manual
- Assist team members with daily claim inquiries and difficult claim processing
- Respond to inquiries from Client Services and Provider Services in a timely manner regarding the reacceptance/revision/reprocessing of claims, claim inquiries, and appeal reviews when necessary
- Coordinate/Manage the set up and processing of dual acceptance claims, as well as the creation and accuracy of client facing documentation
- Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Requirements
- CPC, or other coding certification, strongly preferred
- 2-4+ years of experience within healthcare industry
- Experienced with health/medical insurance and processing of claims
- Expert knowledge of facility claims, billing, and reimbursement
- Knowledge of ICD-10 and CPT coding guidelines
- Proficient in Microsoft Office, including Outlook, Excel, and Word
- Business writing and oral communications proficiency
- Ability to multitask and strong attention to detail
- Diligent research and organizational skills
- Demonstrates solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers
- Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue
- Computer proficiency and technical aptitude with the ability to utilize CMS, EncoderPro, other audit software and tools, MS Office Suite
- Thorough knowledge of company and departmental policies and procedures
Benefits
- 401k plan with employer match
- Flexible paid time off
- Holidays
- Parental leaves
- Life and disability insurance
- Health benefits including medical, dental, vision, and prescription drug coverage