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Reimbursement Specialist - Denials

Posted: October 22, 2024
Salary:Up to US$46350.00 per year + 20% bonus
Location:Friendswood
Job type: Permanent
Discipline:Life Sciences
Reference:235054_1729615682
Work Location:Remote

Job description

Job Description

  • Answer incoming calls from patients, clinician offices, and area sales managers to answer billing-related questions. Educate callers on our reimbursement process, billing policy, and the need for required documentation for appeals and ease any concerns.
  • Request relevant medical records from clinician offices and ensure appropriate documentation is received and conduct follow-up with the office when applicable.
  • Review medical records for key details and create custom medical records and appeal cover letters.
  • Make outbound calls to patients regarding patient consent appeal requirements and effectively communicate the reimbursement process.
  • Review insurance denials, and insurance company medical policies and submit custom appeal letters.
  • Review and resolve front-end claim issues for timely and accurate claim submission.
  • Place outgoing calls or emails to patients, physician offices, and sales for required information.
  • Review EOBs and electronic remittance advice, and denial letters, assign appropriate ANSI codes, and take the necessary action in the billing system.
  • Place calls to insurance companies to obtain missing information and/or determine the status of submitted claims as needed.
  • Utilize payer portals or place follow-up calls to payers for claim status.
  • Posting insurance, client, and patient payments and taking the necessary action in the billing system
  • Provide additional documentation to payers when requested to fully adjudicate claims.
  • Review and submit medical records and appeals to provide proof of medical necessity/criteria to payers.
  • Investigate, evaluate, and report payer trends to identify opportunities for process improvement.
  • Responsible for working various billing-related work queues in the billing system.
  • Identify and report changes to insurance company processing requirements.

Qualification:

  • At least 2-3 years three years of health insurance billing, medical record review, and appeal submission in the molecular diagnostic laboratory space.

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Medix is acting as an Employment Agency in relation to this vacancy.