Sound Physicians, Inc.
Billing Specialist, Denials Management - Remote
Sound Physicians, Inc., Washington, District of Columbia, us, 20022
Job Category:
FINANCE, ACCOUNTING AND REVENUE CYCLE OPERATIHeadquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.Sound Physicians offers a competitive benefits package inclusive of the items below, and more:Medical insurance, Dental insurance and Vision insuranceHealth care and dependent care flexible spending account401(k) retirement savings plan with a company matchPaid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policyTen company-paid holidays per yearAbout the Role:The Denials Management Billing Specialist is responsible for following payor guidelines, legislation and regulations. They are responsible to track, trend and provide root cause analysis of denials received by payors. The Specialist works to eliminate denials allowing the organization to realize a decrease in the volume of denied accounts and dollars. Candidates should have experience with a minimum of one of our core service lines.The Details:
This opportunity is a remote, work from home role.In this role, you will be responsible for:Auditing denial adjustment requests from billing vendors, field operations and Sound Physician staffWorking closely with Regional Operations, Contracting, Coding, Compliance, Payers, Billing companies and the Denials Committee to address issues affecting appropriate reimbursementResearching and analyzing denial trending and root cause by payer and region. Compiling data on inappropriate high volume denial types and working with payors, contracting and billing companies to resolveMaintaining documentation and participating in external audits in order to validate compliance with Sound Physicians policies surrounding denial adjustment requestsParticipating in Denials Management Committee meetings and providing feedback on areas requiring improvement for denials resolutionReviewing, working and trending vendor escalationsReviewing denial and payer trends for resolutionPartnering with vendor to resolve denial and unpaid claimsReconciling approved adjustments to ensure that they have been posted and closed in the billing system timely, ensuring aging buckets do not increaseAssisting department leadership with ad-hoc reports, research, analysis and special projectsManaging time effectively to complete assignments within established time frames, optimizing collections, and meeting performance goalsOther duties as assignedWhat we are looking for:A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience:Values:Work Ethic:
Dedication to getting the job done well and on time, regardless of circumstances, a can-do attitude“Can-do” Attitude:
Proactively seeks assignments, solutions and takes action where and as neededCoachable:
Demonstrates a willingness to accept feedback from others and put it into practiceCustomer-focused:
Puts customer (internal and external) needs first and makes customers their top priorityEager to Learn:
Proactively seeks out information, embraces learning new things and enjoys the learning processTeam Player:
Proactively seeks to work with others to accomplish a common goal. Willingness to share challenges and successes with othersAdaptability:
Demonstrates flexibility and a willingness to change as circumstances evolve and be coachableResourceful:
Proactive willingness to utilize available information and tools to figure things out, not afraid to ask questions when necessaryCommitted:
Demonstrates a dedication to the job, project, organization, customer/clients, and co-workersKnowledge:High school diploma or equivalent requiredAdvanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business related softwareKnowledge and skilled in the use of a computers and related systems and softwareMaintains current knowledge base for regulations: state, federal, and commercial payorsExperience:3-5 years’ experience in medical insurance authorization, billing, patient accounts or related role requiredExperience in denial and claims resolution requiredSound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.
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FINANCE, ACCOUNTING AND REVENUE CYCLE OPERATIHeadquartered in Tacoma, WA, Sound Physicians is a physician-founded and led, national, multi-specialty medical group made up of more than 1,000 business colleagues and 4,000 physicians, APPs, CRNAs, and nurses practicing in 400-plus hospitals across 45 states. Founded in 2001, and with specialties in emergency and hospital medicine, critical care, anesthesia, and telemedicine, Sound has a reputation for innovating and leading through an ever-changing healthcare landscape — with patients at the center of the universe.Sound Physicians offers a competitive benefits package inclusive of the items below, and more:Medical insurance, Dental insurance and Vision insuranceHealth care and dependent care flexible spending account401(k) retirement savings plan with a company matchPaid time off (PTO) begins accruing immediately upon start date at a rate of 15 days per year, in accordance with Sound's PTO policyTen company-paid holidays per yearAbout the Role:The Denials Management Billing Specialist is responsible for following payor guidelines, legislation and regulations. They are responsible to track, trend and provide root cause analysis of denials received by payors. The Specialist works to eliminate denials allowing the organization to realize a decrease in the volume of denied accounts and dollars. Candidates should have experience with a minimum of one of our core service lines.The Details:
This opportunity is a remote, work from home role.In this role, you will be responsible for:Auditing denial adjustment requests from billing vendors, field operations and Sound Physician staffWorking closely with Regional Operations, Contracting, Coding, Compliance, Payers, Billing companies and the Denials Committee to address issues affecting appropriate reimbursementResearching and analyzing denial trending and root cause by payer and region. Compiling data on inappropriate high volume denial types and working with payors, contracting and billing companies to resolveMaintaining documentation and participating in external audits in order to validate compliance with Sound Physicians policies surrounding denial adjustment requestsParticipating in Denials Management Committee meetings and providing feedback on areas requiring improvement for denials resolutionReviewing, working and trending vendor escalationsReviewing denial and payer trends for resolutionPartnering with vendor to resolve denial and unpaid claimsReconciling approved adjustments to ensure that they have been posted and closed in the billing system timely, ensuring aging buckets do not increaseAssisting department leadership with ad-hoc reports, research, analysis and special projectsManaging time effectively to complete assignments within established time frames, optimizing collections, and meeting performance goalsOther duties as assignedWhat we are looking for:A successful candidate will have a demonstrated track record of a combination of these values, knowledge, and experience:Values:Work Ethic:
Dedication to getting the job done well and on time, regardless of circumstances, a can-do attitude“Can-do” Attitude:
Proactively seeks assignments, solutions and takes action where and as neededCoachable:
Demonstrates a willingness to accept feedback from others and put it into practiceCustomer-focused:
Puts customer (internal and external) needs first and makes customers their top priorityEager to Learn:
Proactively seeks out information, embraces learning new things and enjoys the learning processTeam Player:
Proactively seeks to work with others to accomplish a common goal. Willingness to share challenges and successes with othersAdaptability:
Demonstrates flexibility and a willingness to change as circumstances evolve and be coachableResourceful:
Proactive willingness to utilize available information and tools to figure things out, not afraid to ask questions when necessaryCommitted:
Demonstrates a dedication to the job, project, organization, customer/clients, and co-workersKnowledge:High school diploma or equivalent requiredAdvanced understanding/knowledge of computer data entry, Microsoft Excel and ability to navigate through any business related softwareKnowledge and skilled in the use of a computers and related systems and softwareMaintains current knowledge base for regulations: state, federal, and commercial payorsExperience:3-5 years’ experience in medical insurance authorization, billing, patient accounts or related role requiredExperience in denial and claims resolution requiredSound Physicians is an Equal Employment Opportunity (EEO) employer and is committed to diversity, equity, and inclusion at the bedside and in our workforce. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, gender identity, sexual orientation, age, marital status, veteran status, disability status, or any other characteristic protected by federal, state, or local laws.This job description reflects the present requirements of the position. As duties and responsibilities change and develop, the job description will be reviewed and subject to amendment.
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