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Reimbursement Specialist
Ref No.: 18-01523
Location: Westfield, New Jersey

Monitoring and working the workflow dashboard for assigned providers and specialties, to include researching and correcting claims on MGRHOLD, writing appeals and facilitating their submission by Athena for appealing adverse decisions, contacting payers and Medical Directors as needed, and all other activities that lead to the successful adjudication of eligible claims. Oversight of HOLD and monitoring of MISSING SLIPS for assigned providers and specialties. Any coding and charge entry based on assigned providers and specialties. Completing claims worklists assigned by Reimbursement Supervisor. Bi-monthly reporting of dashboard status to Reimbursement Supervisor via Excel spreadsheet or other template to include aged since last touch balances and error reasons. Run reports for distribution to the physician and physician staff as needed to communicate data of interest, work performed, or ad hoc. Complete system knowledge, ability to run reports, worklists, and research and resolve an assigned subset of Unpostables, payment batches. Responsible for running the Zero Pay Worklists at a minimum of bi-weekly for assigned providers and specialties, reviewing and responding to adjustments with approval or appeal. Field Patient Accounts staff or practice-based patient balance due questions and complaints as well as insurance needs on behalf of assigned providers and specialties. Receive transferred calls or emails from Patient Accounts staff with patients requesting advanced assistance with their account. Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws.

Required Skills/Experience:

Expert skills required in athenaCollector co-sourcing model. Expert in management and resolution of items in the MGRHOLD Bucket: -Rules versus denials - kickcodes (what they are and what they do) - Claim note history including actions and claim statuses Expert in Oversignt and Guidance/Management of HOLD bucket and Missing Tickets for assigned AR. Expert in EOBs and ERA and what they mean in athenaNet. Expert in generally accepted insurance benefit terms and processes, in quickview, Registration, and Claim Edit Screens. Expert in request/preparation of supporting documents such as medical records, dictation, appeal letters, contract pages. Strong planning and organizational skills required Strong problem solving and decision making skills required. Experience with AthenaCollector and Anodyne preferred. Familiar with modifiers, CPT, and ICD-9 resources in Athena.