Easter Seals Jobs

JOB REQUIREMENTS: Overview Responsible for ensuring claims are resolved with third party payers in a reasonable time frame as defined by Revenue Cycle metrics. This includes working claims that fail payer rejection edits in order to resolve errors and submit corrected claims. Assesses errors and quickly and effectively locates information to correct them and follow-up on claims for resolution. Works with other areas in the Revenue Cycle to obtain information necessary to correct errors or supply additional information as necessary for claim adjudication. Remains up-to-date on regulatory requirements through informal and formal updates, including self-study of payer bulletins and guidelines. Performs other duties as assigned. Responsibilities Essential Duties and Responsibilities Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use. Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow-up. After denial review, evaluates next steps and takes action to call payer, follows up with a resubmission or dispute/appeal/reconsideration as required by payer, or works internally to receive payment on account. Drafts an appeal or complete reconsideration forms when applicable based on payer requirements in a format that is logical and relates to the open denial of payment. Obtains and sends medical records during the appeals process when needed to substantiate medical necessity. Ability to review billing forms for both paper submissions and electronic submissions for accuracy. Calls patients or payers directly without hesitation to obtain needed information to resolve an account balance when applicable. Identify trends with payor rejections or denials and escalates these trends to leads/supervisors. Uses computer systems/technology to locate claims information to resolve account balances. Maintains compliance with patient financial services policies and procedures. Uses fax machine and other office equipment during the course of normal daily operations. Reviews accounts based on patient or departmental inquiries. Also, works and follows up with other Mercyhealth departments in a timely fashion if outstanding questions are not resolved and a claim is in jeopardy of not being paid. Interacts with other PFS staff members to provide pertinent information and to ask for guidance to resolve knowledge base deficiencies. Researches accounts at a higher level that are denied for No Authorization as a priority in the attempt to appeal or escalate to Precertification department if a retro authorization may be needed. Works billing functions when needed. Escalates high dollar accounts for a second level appeal if... For full info follow application link. EOE&AA/M/F/Vet/Disabled. Mercy is an equal employment opportunity employer functioning under Affirmative Action Plans. ***** APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/FAE495D7F48E442A