The C & D specialist is responsible for reviewing accounts which have been denied or underpaid by third party payers and to resolve the issues resulting in denial/underpayment and to formally appeal. The specialist will conduct comprehensive reviews of clinical documentation to determine if an appeal is warranted. Should an appeal be necessary, the specialist will write compelling and factual arguments which will then be sent to the insurance carrier. The specialist will work across departments to gather the appropriate documentation and information for a clear and concise appeal.
Responsibilities will include basic knowledge of medical billing, medical claims processing and accounts receivable collections. The Medical collection specialist must have the Ability to learn and understand medical billing protocol and reimbursement issues, work within Meditech and Emdeon to identify denial trends as well as be responsible for locating and monitoring overdue third party accounts preventing write off. Must be comfortable working tight deadlines, have the ability to analyze and trouble shoot billing concerns and communicate concerns with management.
Required: 1-2 years in accounts receivable experience OR 1 year in a healthcare setting.
Preferred: 3 years of Medical office or denial management experience