Responsibilities
- Utilize the phone system application by logging in and setting a status of ready to manage incoming phone calls by responding to request and assisting with inquiries.
- Identify and research eligibility through multiple web portals, collects needed information to ensure timely processing of electronic, portal, and invoiced claims.
- Follow revenue cycle processes from charge creation through resolution of outstanding AR.
- Monitor AR related to service authorizations to ensure payment.
- Verify eligibility when required prior to billing payers and documents insurance verification.
- Generate monthly charges and transmission of assigned claim groups.
- Assist in investigating and resolving claim rejections and denials via Clearinghouse or payer portals.
- Utilize payer portals or contact payers as needed for claim corrections and/or missing information.
- Add and understand specific data such as modifiers, payer specific information, including authorization criteria, CPT and ICD-10 coding.
- Apply corrections to patient demographics, charges, adjustments, and payments or when needed forwards to the appropriate department for correction.
- Handle reporting cards and tickets assigned through company applications.
- Handle rejection and denial workgroups for timely review and resubmission of EDI claims.
- Assist with resolving problems by clarifying issues, researching potential solutions, helping to implement changes to maximize timely and complete reimbursement, and escalating unresolved issues.
- Utilize multiple system applications daily to work through assigned inventory.
- Identify and documents any payer issues and communicate with RCM leadership.
- Audit and validates all billing functions to reduce potential fraud and incorrect billing.
- Update and cross checks all billing procedure codes in the system.
- Provide subject matter expertise in all systems utilized in the Revenue Cycle to aid in learning and process improvement.
- Follow SOX compliance within systems as outlined.
- Perform resubmission projects and additional daily reports.
- Participate in other projects or duties as assigned.
Requirements
- High School Diploma required.
- Zero (0) plus years of experience. Or equivalent combination of education and/or experience.
- Strong attention to detail and accuracy.
- Basic understanding of claims, billing and invoicing processes.
- Proficient in the use of computer software and data entry.
- Excellent written and verbal communication and interpersonal skills.
- Ability to work effectively in a team-oriented environment.
- Basic problem-solving skills.
- Time management and organizational abilities, ability to manage multiple tasks.
- Customer service-oriented mindset.
- Self-motivation and the ability to work independently and with teams.
- Literate in healthcare, specifically in Medicaid and Medicare Advantage environments.
- Ability to handle highly sensitive data with confidentiality and integrity.
- Proficient in the use of Word, Excel, Outlook, and PowerPoint.
Benefits
- Medical, Dental, and Vision insurance
- Employer Paid Basic Life Insurance and AD&D
- Voluntary Life Insurance (Employee/Spouse/Child)
- Health Care and Dependent Care Flexible Spending Accounts
- Pre-Tax and Post-Tax Commuter and Parking Benefits
- 401(k) Retirement Savings Plan with Company Match
- Paid Time Off
- Paid Parental Leave
- Short-Term and Long-Term Disability
- Tuition Reimbursement
- Employee Discounts (retail, hotel, food, restaurants, car rental and much more!)
Additional Information
- Positions may be posted for a minimum of 5 days and up to 45 days depending on the role and number of applications.
- Candidates are encouraged to apply promptly to avoid missing opportunities.
- Modivcare is an Equal Opportunity Employer.
- EEO is The Law - click here for more information
- Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled
- Consideration for employment is without regard to race, color, religion, sex, sexual orientation, national origin, age, handicap or disability, or status as a Vietnam-era or special disabled veteran.
- Assistance for applicants available at hr.recruiting@modivcare.com
