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Job description
Claim Edits and Insurance Denials SpecialistThis position is a work from home positionFlexible Schedule - Monday - Friday: 6:00AM - 6:00PMClaim EditsResponsible for researching patient billing claims to identify and correct coding/claim errorsResponsible for researching patient insurance coverage to identify and resubmit claims to fix coverage denials.Research and outline documentation needed for respective payor organizations so that claims are processed correctlyFamiliarity with NCCI edits, incidentals/inclusive, and bundling rules, etc.Identify problem trendsCommunicate with payors for resolution to complications with claimsResponsible for 277 EDI transactions/rejectionsWorking with EDI transactionsPayment posting corrections/adjustments and ability to distribute paymentsCorrect/enter chargesWork with multiple teams/departments to resolve issuesPayment plan or financial assistance coordinationInsurance Denials and Follow-UpResponsible for researching, identifying errors, and correcting claims denied by insurance companies.Must be able to assess claim to determine when appropriate to make charge adjustments, void a charge, or escalate to the team lead and/or another medical billing team.Responsible for writing appeal letters to insurance companiesResponsible for following up with insurance companies for no response claims.Responsible for working with patient calls escalated from the Customer Service team regarding involving billing code issues.Research refund request from payor organizationsResponsible for preliminary audit of billing code errors before claim submitted to the Coding team.Responsible for routing complex claim denial to team lead and/or the appropriate medical billing team.Responsible for identifying issues which can be resolved by programming software to prevent denials.Responsible for becoming a subject matter expert on the payor policies.Responsible for communicating and resolving problems with the provider representativesResponsible for simple level coding, including diagnosis review, modifier applications, some CPT cod changes following process documents and payor policiesCandidate must live in or around the Kansas City metropolitan area.Job Requirements2 yearsDiplomaFull Time Day (United States of America)
Worksite address
kansas city, MO, 64101, US
Who can apply
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