Insurance Denials and Appeals Clerk Job Katy area,Texas USA,Healthcare

Position: Insurance Denials and Appeals Clerk Spring Branch Community Health Center

SUMMARY

The Insurance Denial & Appeals Clerk is responsible for maintaining current patient accounts. Handles insurance claim denials, rejections and resubmission of claims. The position reviews third party payer reimbursement denials based on the following: documentation, billing accuracy, medical necessity, coding, modifier and related issues. Uses data from these reviews to identify and rectify billing and documentation errors, maintain and communicate denial / appeal activity to appropriate staff and report suspected or emerging trends related to payer denials to Billing Manager.

QUALIFICATIONS

High school graduate or equivalent
2 years’ experience preferred in managing insurance appeals and denials
Extensive knowledge of third party billing and payment methodologies required
Knowledge of CPT, ICD-10-CM, HCPCS, and modifiers necessary
Excellent computer skills including Excel, Word, and Internet use
Detail oriented with above average organizational skills
Plans and prioritizes to meet deadlines
Good oral and written communication skills
Ability to deal professionally, courteously and efficiently with the public and all levels of the organization
Ability to handle multiple projects simultaneously
Ability to operate computer, copier, fax
Proficient in practice management system and Microsoft Office software applications
Knowledge of HIPAA guidelines and requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement.

Receives denied claims and researches appropriate appeal steps.

Communicates directly with the payer, resubmits denied claims, underpaid claims and claims that are inaccurately processed.

Tracks and documents all denials by payer, visit type and denial category.

Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to eliminate future denials.

Works with the payers to understand specific reasons for denials and preventable measures available to prohibit future denials.

Process patient refunds in a timely manner, submitting refund requests at the time of insurance payment/EOB receipt.

Communicate with multiple levels in the organization (e.g, managers, physicians, clinical and support staff).

Maintain confidentiality of sensitive information

Work closely with the billing manager and billing staff to identify and resolve any denials issues related to provider credentialing.

Work special projects set by billing manager.

Other duties as assigned.

Cross trained to provide billing department coverage in any task needed to meet end of the month deadlines.

Responsible for staying current with the rules and updates or changes in state and federal regulations.

Continually search for ways to improve the accounts receivable process, striving for efficiency in daily operations.

All Health Center staff members have emergency and disaster response responsibilities. Participates in all safety programs which may include assignment to an emergency response team.

BENEFITS

Paid Time Off
10 Company holidays
1- 8-hour Personal holiday
401(k) retirement plan- employer matches up to 5%
Bereavement Leave
Continuing Education
Employee Assistance Plan
Student Loan Forgiveness- if applicable
Medical, Dental, Vision – Aetna
Basic Life ($35k)/AD&D – 100% paid for by the employer
Employee Assistance Plan (EAP) – 100% paid for by the employer
Additional benefits available at employee expense:
- Additional Voluntary Life Insurance
- Short-Term Disability (STD)
- Long-Term Disability (LTD)
- Accident Insurance
- Critical Illness Insurance
- Hospital

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