Job Description

This role focuses on efficiently submitting electronic claims to commercial payers, ensuring minimal edits or drops. The position involves tracking and managing denials, particularly those related to medical necessity, and filing timely appeals. The successful candidate will monitor aging reports and resolve stalled or underpaid claims while collecting patient financial responsibilities in compliance with regulations.

Key Responsibilities:

• Submit electronic claims cleanly to commercial payers to minimize initial edits or drops.
• Track and manage denials caused by issues such as lack of medical necessity and file timely appeals.
• Monitor aging reports to identify stalled or underpaid claims and take necessary actions.
• Collect patient financial responsibilities while ensuring compliance with relevant regulations.

Required Qualifications:

• Basic Excel skills are required to manage and analyze claims data effectively.
• Experience with hospital, rehab, or LTACH collections is necessary for understanding the claims process.
• Knowledge of denials and appeals processes is essential for managing claim issues.
• Experience handling production goals, specifically managing 25 accounts per day, is preferred.
• Ability to monitor aging reports, particularly those aged 30, 60, and 90+ days, is needed.
• Familiarity with commercial payers like Aetna, BlueCross, and UnitedHealthcare is beneficial.

Additional Details:

• Location: Miami, FL 33101

This fully remote position offers a competitive pay rate and flexibility with login times, making it an excellent opportunity for those looking to thrive in a dynamic healthcare billing environment.

#12058

Job Tags

Full time, Remote work

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