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Job description
About the Role
Impact you will make
Are you an expert in healthcare insurance reimbursement? Do you thrive on solving complex insurance denials and underpayments? Join our team and play a vital role in ensuring hospitals receive the reimbursements they deserve.
We're looking for an experienced Healthcare Denials Specialist to analyze and resolve payer denials and underpayments. You'll be part of a dynamic team using cutting-edge ARO software to streamline medical claims and collections. As a Denials Specialist II, you will also have the opportunity to mentor junior representatives.
Reps typically demonstrate the aptitude and ability to take on critical processes while managing quality production standards. Acts as a mentor to Rep I& Rep IIassociates.Responsible for managing moderately complicated insurance denials and underpayments via theRubixisAR Follow Up software.
What you will do
Learn and understand ourRubixisplatform and the various resources available
Work an assigned number of accounts from start to finish successfully, and in a timely manner
Call healthcare insurance companies, their affiliates & providers to resolve any question about contract or payment issues
Analyze contract, billing, cash costing, pricing, and collections on accounts in compliance with billing regulations,policies,and
Procedures
Investigate all insurance payments that deviate from expected payment
Work collaboratively with leadership and other team members to confirm, challenge, or provide trending and solutions
What you will bring
5+ years Hospital Billing with follow up experience, with advanced knowledge of all pay or types, who will be able to manage day-to-day operational tasks associated with medical insurance billing and follow
Knowledge of Medicare payer rules, processes, including how to interpret denial reasons, how to submit appeals to Medicare payer, and access Medicare portals
Ability to use Medicare Direct Data Entry (DDE) to submit claim corrections, adjustments, and inquiries as needed
Detailed understanding of insurance follow-up (i.e.,resolving non-paid, denied, under-paid, and rejectedclaims) for healthcare providers
Experience in UB04 Facility Pricing and Reimbursement variance
Good understanding of revenue cycle
Basic understanding of HIT systems like EPIC, Paragon,Zirmed,or other billing systems
Problem solving / superior analytical skills
An organized and detail-orientedaptitude
What we would like to see
Bachelor's or associate degree
2+ years of experience in UB-04 Follow-Up and/or Contract/Reimbursement Analysis, including investigation of both pricing and reimbursement variances
2+ years of experience with Medicare processes and systems
Detailed knowledge of Facility Reimbursement contracts, fee schedules, reimbursement procedures
Advanced MS Excel skills
FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.
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About FinThrive
FinThrive is advancing the healthcare economy.
For the most recent information on FinThrive's vision for healthcare revenue management visit finthrive.com/why-finthrive.
Award-winning Culture of Customer-centricity and Reliability
At FinThrive we're proud of our agile and committed culture, which makes FinThrive an exceptional place to work. Explore our latest workplace recognitions at careers#culture.
Our Perks and Benefits
FinThrive is committed to continually enhancing the colleague experience by actively seeking new perks and benefits. For the most up-to-date offerings visit finthrive.com/careers-benefits.
FinThrive's Core Values and Expectations
Demonstrate integrity and ethics in day-to-day tasks and decision making, adhere to FinThrive's core values of being Customer-Centric, Agile, Reliable and Engaged, operate effectively in the FinThrive environment and the environment of the work group, maintain a focus on self-development and seek out continuous feedback and learning opportunities
Support FinThrive's Compliance Program by adhering to policies and procedures pertaining to HIPAA, FCRA, GLBA and other laws applicable to FinThrive's business practices; this includes becoming familiar with FinThrive's Code of Ethics, attending training as required, notifying management or FinThrive's Helpline when there is a compliance concern or incident, HIPAA-compliant handling of patient information, and demonstrable awareness of confidentiality obligations
Physical Demands
The physical demands and work environment characteristics described here are representative of those that a colleague must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Statement of EEO
FinThrive values diversity and belonging and is proud to be an Equal Employment Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We're committed to providing reasonable accommodation for qualified applicants with disabilities in our job application and recruitment process.
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FinThrive is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.
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Who can apply
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