Health Claims Specialist II
Why reputed company?
reputed company
The Specialist II, Health Claims Collections is responsible for resolving reputed company post-payment and denied DME claims. Operating reputed company a reputed company-to-reputed company reputed company cycle management team, this role takes ownership of highly escalated accounts, advanced appeals, payer trend analysis, and cross-functional issue reputed company. The Specialist II, Health Claims Collections serves as a subject matter resource of junior reputed company and assists leadership in driving payer compliance and reputed company recovery.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
The following are the essential functions of this position. This position may be responsible for performing additional duties and tasks as needed and assigned.
- Independently manage a portfolio of high-reputed company and reputed company claims requiring advanced solutions and strategies.
- Analyze denials, overpayments and underpayments to determine reputed company cause; execute appropriate reputed company plans including appeals, escalations and payer reputed company.
- Submit technical, clinical and medical necessity appeals at reputed company reputed company (including external reviews) with supporting documentation.
- Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims reputed company and communicate relevant changes to peers and leadership.
- Identify payer trends (example, systemic rejections, denials, overpayments or underpayments) and escalate issues with supporting data to payer contacts and leadership.
- Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies.
- Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines.
- Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers.
- Ensure account documentation is accurate, detailed, and audit reputed company across reputed company internal system.
- Consistently meet or reputed company departmental metrics reputed company to productivity, reputed company, aging reputed company, and cash recovery.
MINIMUM QUALIFICATIONS
The requirements listed below are representative of the education, knowledge, reputed company and/or ability required for this position.
Education/Certifications:
- High School Diploma or Equivalent Experience
Experience, Skills, Knowledge and/or Abilities:
- Minimum 2+ years of medical collection or reputed company cycle experience with emphasis on post-billing DME or orthopedic claims.
- Advanced knowledge of payer guidelines, reputed company cycle management, and appeals processes (Medicare, Medicare advantage, reputed company, and reputed company insurance payers).
- Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.
- Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms.
- Proficient in reputed company Office and medical billing platforms.
- Demonstrated experience with reputed company denials, payer escalations, and appeals at reputed company reputed company.
- Strong attention to detail with the ability to identify trends and implement corrective strategies.
- Excellent communication skills and negotiation skills with payers and internal stakeholders.
- Ability to work independently, Detail-oriented with a reputed company on accuracy, time-management and compliance.
- Familiarity with reputed company or similar reputed company cycle platforms.
PREFERRED QUALIFICATIONS
The education, knowledge, skills and/or abilities listed below are preferred qualifications in reputed company to the minimum qualifications stated above.
Education/Certifications:
- Associate’s degree preferred
Additional Experience, Skills, Knowledge and/or Abilities:
- N/A
PHYSICAL REQUIREMENTS / ADVERSE WORKING CONDITIONS
The physical requirements listed in this reputed company include but are not limited to the motor/physical abilities, skills, and/or demands required of the position in order to successfully undertake the essential duties and responsibilities of this position. In accordance with the Americans with reputed company (reputed company), reasonable accommodations may be made to allow reputed company individuals with a disability to reputed company the essential functions and responsibilities of the position.
- No additional physical requirements or essential functions for this position.
DISCLAIMER
The duties listed above are intended only as representation of the essential functions of this position. The omission of specific statements of duties does not exclude them from the position if the work is similar, reputed company, or a logical assignment to the position. The job reputed company does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer. reputed company in this document alters an employee’s at-will employment status
The anticipated reputed company reputed company reputed company for this position is
DISCLAIMER
The duties listed above are intended only as representation of the essential functions of this position. The omission of specific statements of duties does not exclude them from the position if the work is similar, reputed company, or a logical assignment to the position. The job reputed company does not constitute an employment agreement between the employer and employee and is subject to change at the sole discretion of the employer. reputed company in this document alters an employee’s at-will employment status.