Medical Claims Denial and AR/Appeals Specialist

Medenet is searching for a confident professional who combines excellent billing and/or AR skills, along with customer service skills. This position is part of a team that is responsible for account reconciliation, research, appeals and collection for all accounts receivables on assigned divisions. Must be able to work in a fast-paced environment. Must possess time-management and organizational skills.

Knowledge of Various Medical Specialties especially DME and Can Multi-task and Work in a fast-paced environment

Key Responsibilities:

• Responsible for maintaining up to date patient account records. Responds to clients/providers, insurance and patient inquiries, whether verbal or written. Analyses and pursues past due insurance and patient payments utilizing accounts receivable reports. Handles insurance claim denials, rejections, and resubmission of claims
• Understand and comply with billing regulations/policies including but not limited to Medicare and Medicaid programs.
• Documentation and follow-up entries on accounts
• Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement.
• Receives denied claims and research appropriate appeal steps
• Communicates directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. and also using appropriate reports and working queues
• Identifying and updating incomplete or missing information on accounts
• Use strategy and tact with insurance companies to resolve accounts
• Effectively communicate patient and clinical issues
• Other Duties Assigned

Specialized knowledge:

• Excellent written and verbal communication skills and understanding for various medical specialties
• Must be computer savvy and proficient in Microsoft Office
• Knowledge of HIPAA guidelines and requirements
• Experience with Practice Management Systems preferred.
• Extensive knowledge of third-party billing and payment methodologies required.
• Good oral and written communication skills and knowledge of various computer programs and electronic remittances.
• Knowledge of CPT, ICD-9/10-CM, HCPCS, and modifiers necessary.
• Effective interpersonal skills with the ability to maintain a self-directed and professional approach to completing daily duties.

Qualifications:

· Must be 18 years of age or older

· 3-5 years of A/R follow up with insurance on claims (direct contract with insurances)

· Full understanding of the insurance denials / appeals process

· CPC Preferred

· Excellent computer skills with emphasis on use of Excel spreadsheets

· High School Diploma or GED, some college preferred

Job Type: Full-time

Pay: $15.00 - $25.00 per hour

Expected hours: 30 – 40 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Hybrid work
• Office

Experience:

• ICD-10/CPT: 2 years (Required)

Work Location: Hybrid remote in Saint Petersburg, FL 33716