Rev Cycle Denials Recv Rep 2 - Govt

The Revenue Cycle Denial Rep 2 manages the accounts receivable in accordance with compliance regulatory and billing guidelines and specific payer rules. Responsible for handling escalated denials based on payer issues. Handles complex edits, appeals and account activities such as advanced level tasks, appeal processing, and account follow-up. Acts as a billing and reimbursement expert for a defined payer product line. Works collaboratively with other departments such as Billing, Coding, Cash Posting, etc. to ensure claims are processed/paid correctly. Navigates payor policies/portals for claims tracking/appealing purposes.

Education: Associate's degree preferred.

Work Experience:

• One (1) year customer service experience in health care, or related field, required. Revenue Cycle denial experience preferred. Proficient computer knowledge related to Microsoft Office applications such as Word, Excel, Outlook, Teams, etc.

Displays a high standard of confidentiality; strong written and oral communication skills; ability to deal with a large volume of work and the ability to multitask. Maintains a comprehensive working knowledge of assigned payer billing policies and guidelines. Work proficiently within revenue cycle billing systems; attention for details; ability to prioritize and complete tasks under demanding conditions; ability to easily accept and implement change. Additionally, has the ability to critically think and solve complex problems and issues with minimal or no supervision. Knowledge of basic medical coding and third-party operating procedures and practices.

Essential Functions

• Works collaboratively with other Revenue Cycle Departments i.e. Billing, Cash, Coding, etc. to evaluate payments and/or denials based on fee schedules/contracts.
• Navigates/Interprets payor websites, portals, submits reconsiderations/appeals, etc. in order to ensure claims are processed correctly/efficiently.
• Handles escalated appeals.
• Assists with training and education to staff for accuracy.
• Identifies payer and system issues to initiate project requests for process improvements.
• Attends and participates in meetings with payer specific provider representatives to maximize reimbursement and minimize denials through problem solving, collaboration and consensus.
• Compiling claim issues into standardized templates in order to share payor issues/trends with the appropriate payor provider reps.
• Identifies, prepares, and requests adjustments.
• Identifies and resolves insurance set up errors to facilitate accurate and timely billing.
• Submits claims for assigned payers, including corrected and voided claims.
• Reviews and resolves incoming correspondence for outstanding accounts receivables.
• Complete/Track Recovery Audits (RAC) for State/Federal payors.

Find it here.

Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance - and opportunities meet flexibility. Find it all at Carle Health.

Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world's first engineering-based medical school, and Health Alliance. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.