Revenue Cycle Claims Denials and Appeals Specialist (temp-to-hire) - Remote

Overview

The Revenue Cycle Denials and Appeals Specialist will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes impacting cash collections.

In Short

• Serves as a source of knowledge for the designated revenue cycle function, with a focus on Denials and Appeals.
• Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement.
• Responsible for developing appropriate workflows and tracking for the designated revenue cycle function.
• Establishes an ongoing working relationship with other departments impacting revenue cycle performance.
• Works closely with various vendor operations teams to oversee operations activity that impacts the revenue cycle.
• Tracks outcomes of payment resolution, appeals, and negotiated claims.
• Leads weekly meetings to review key metrics and performance improvement opportunities.
• Researches, evaluates, and interprets guidance from various sources to determine departmental actions.
• Coordinates with Management to ensure understanding of trends/issues affecting revenue cycle performance.
• Develops goals and metrics to link department initiatives with the organization’s strategy.

Requirements

• At least 3 years of experience in medical billing and Insurance collections.
• At least 3 years of experience with Prior Authorization requirements and Appeals.
• Knowledge of CPT/HCPCS, ICD-10, and UB revenue codes.
• Healthcare related field of study or equivalent experience.
• Proficiency with medical billing systems and Microsoft Excel.
• Strong communication, organizational, and problem-solving skills.
• Ability to analyze, identify, and articulate trends.
• Ability to solve problems using critical thinking skills.
• Analytical skills required.
• Ability to develop, implement and produce analysis and reports.

Benefits

• Competitive Benefits including medical, dental, vision, life and disability plans.
• Free testing for employees and their immediate families.
• Fertility care benefits.
• Pregnancy and baby bonding leave.
• 401k benefits.
• Commuter benefits.
• Generous employee referral program.