InterMED
Denial Specialist
InterMED, South Portland, Maine, us, 04106
ESSENTIAL FUNCTIONSReview for appropriate insurance requirements(i.e. modifiers)Review of patient demographics (address, telephone #, guarantor changes, etc.) and insurance (certificate #, new primary or secondary coverage, etc.) for accuracy and completenessEnsure provider information is correctOnce claims have been processed by the insurer, resolve any claim rejections or denialsReview all ERAs (Electronic Remittance Advice) by line item to ensure patient balances are correct, the correct contractual adjustments have been done according to contracts, and the claims are in the correct status within the practice management systemProcess refunds based on the protocol of the applicable insurer . Review and manage the insurance aging analysis for the insurersSubmit appeal/reconsideration requests to insurersFollow up on appeal/reconsideration requestsReport denial trends to the Billing SupervisorJOB REQUIREMENTS
High school diploma or GED requiredOne to three years of accounts receivable experience (preferably in Health Care) preferredCPC (Certified Coding Professional) preferredKnowledge of accounts receivable practices and medical billing office proceduresKnowledge of insurance reimbursement procedures and practicesAbility to work effectively with co-workers as a team memberAbility to maintain the confidentiality of patient information in accordance with company policy & procedure, and HIPAA regulations.Ability to communicate effectively and clearlyMust be able to work quickly and accuratelyExcellent critical thinking skillsEffective interpersonal communication skills (written and verbal) to deal with sensitive situationsAbility to work effectively with co-workers as a team memberAbility to communicate effectively and clearlyMust be able to work quickly and accuratelyOrganization, time management and prioritization abilitiesProficiency in Microsoft Office suite (Word, Excel, Outlook, and PowerPoint) is required as well as the ability to quickly learn and retain knowledge of how to use the electronic medical record.Proficiency with Windows based computer applicationsAbility to work autonomously and collaboratively with team members, including cross coverage to achieve the overall objectives of the department and organizationAbility to demonstrate and uphold InterMed's Values
InterMed is an equal opportunity workplace and prohibits discrimination or harassment of any kind. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, gender identity and/or expression, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.
High school diploma or GED requiredOne to three years of accounts receivable experience (preferably in Health Care) preferredCPC (Certified Coding Professional) preferredKnowledge of accounts receivable practices and medical billing office proceduresKnowledge of insurance reimbursement procedures and practicesAbility to work effectively with co-workers as a team memberAbility to maintain the confidentiality of patient information in accordance with company policy & procedure, and HIPAA regulations.Ability to communicate effectively and clearlyMust be able to work quickly and accuratelyExcellent critical thinking skillsEffective interpersonal communication skills (written and verbal) to deal with sensitive situationsAbility to work effectively with co-workers as a team memberAbility to communicate effectively and clearlyMust be able to work quickly and accuratelyOrganization, time management and prioritization abilitiesProficiency in Microsoft Office suite (Word, Excel, Outlook, and PowerPoint) is required as well as the ability to quickly learn and retain knowledge of how to use the electronic medical record.Proficiency with Windows based computer applicationsAbility to work autonomously and collaboratively with team members, including cross coverage to achieve the overall objectives of the department and organizationAbility to demonstrate and uphold InterMed's Values
InterMed is an equal opportunity workplace and prohibits discrimination or harassment of any kind. We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, gender identity and/or expression, sexual orientation, marital status, disability, veteran status, or any other basis protected by applicable federal, state or local law.