denial management representative

Jordan Young Institute

<div><p><b>Title: </b>AR Follow-up and Denial Specialist</p><p><b>
Location:</b> Onsite &ndash; Virginia Beach, VA (Hybrid)</p><p><b>
Who we are:</b></p><p>
Aligned Orthopedic Partners is a well-respected private orthopedic team comprised of highly trained, board-certified orthopedic surgeons devoted to delivering patients with the highest orthopedic care possible. Our commitment to finding the best solutions for individual needs sets us apart from the competition. We take pride in providing exceptional care while remaining friendly, courteous, and efficient.</p><p>
Aligned Orthopedic Partners is recruiting an experienced AR Follow-up and Denial Specialist. The ideal candidate is experienced with analyzing and resolving insurance claim denials, correcting errors, and securing accurate reimbursement from payers. This role requires strong analytical, coding, and communication skills, with a focus on denial prevention, timely appeals, and collaboration across the revenue cycle team.</p><p><b>
What you will do:</b></p><p><b>
Claims Review &amp; Correction</b></p><ul><li>
Review denied and unpaid claims to verify coding and billing accuracy.</li><li>
Correct errors and submit revised claims when necessary.</li><li>
Investigate claims with no payer response to confirm receipt and follow up.</li></ul><p><b>
Denial Management &amp; Appeals</b></p><ul><li>
Analyze denials and generate effective, well-researched written appeals.</li><li>
Appeal denials through coding review, contract interpretation, medical record review, and direct payer interaction.</li><li>
Maintain detailed knowledge of payer websites and appeal processes for commercial and government payers.</li><li>
Ensure appeals and reconsideration requests are completed accurately and on time.</li></ul><p><b>
Trend Analysis &amp; Communication</b></p><ul><li>
Identify recurring denial trends or payer policy changes affecting reimbursement.</li><li>
Communicate trends to management and recommend process improvements to prevent reoccurrence.</li><li>
Support and participate in process and quality improvement initiatives.</li></ul><p><b>
Collaboration &amp; Education</b></p><ul><li>
Confer with coders, billing staff, and revenue cycle managers on coding or claim issues.</li><li>
Provide education to team members on payer policies and denial prevention.</li><li>
Collaborate on special projects and assist management with additional tasks as assigned.</li></ul><p><b>
Account Reconciliation</b></p><ul><li>
Work assigned follow-up queues, including identification of missing payments, overpayments, and credits on accounts.</li><li>
Document all actions taken in the practice management system.</li></ul><p><b>
What you bring to the table:</b></p><p>
You are a detail-oriented and dependable professional with a strong grasp of accounts receivable and denial processes. You take ownership of your work, communicate clearly, and consistently meet deadlines in a fast-paced environment. You bring:</p><ul><li>
Minimum of 3 years&rsquo; experience in a medical billing department (orthopedic or surgical experience strongly preferred).</li><li>
In-depth knowledge of healthcare billing, claims processing, payer follow-up, and appeals.</li><li>
Proficiency with payer websites, Microsoft Outlook, Word, and Excel.</li><li>
Coding knowledge sufficient to process denied claims and support appeals.</li><li>
Strong reasoning, critical thinking, analytical, and mathematical skills.</li><li>
Ability to work independently with high productivity and attention to detail.</li><li>
CPC certification preferred but not required.</li><li>
High School Diploma or GED required.</li></ul><p><b>
Equal Opportunity Employer</b></p><p>
Aligned Orthopedic Partners is an equal opportunity employer. We promote diversity of thought, culture, and background. We celebrate what makes us different and committed to building a team that represents a variety of experiences. All employment is decided on the basis of qualifications, merit, and business need.</p></div>

AR Follow-up and Denial Specialist

Lakeland Regional Health

<p></p><div><div><div><div><div>Position Details<br>
</div></div><br>
<div><div><p>Lakeland Regional Health is a leading medical center located in Central Florida. With a legacy spanning over a century, we have been dedicated to serving our community with excellence in healthcare. As the only Provisional Level 1 Trauma center for Polk, Highlands, and Hardee counties, and the second busiest Emergency Department in the US, we are committed to providing high-quality care to our diverse patient population. Our facility is licensed for 910 beds and handles over 200,000 emergency room visits annually, along with 49,000 inpatient admissions, 21,000 surgical cases, 4,000 births, and 101,000 outpatient visits.
</p><p><b>Active - Benefit Eligible and Accrues Time Off
</b></p><p></p><b>Work Hours per Biweekly Pay Period: </b>80.00
<br>
<b>Shift </b>: Monday - Friday
<br>
<b>Location </b>: 210 South Florida Avenue Lakeland, FL - Remote after training
<br>
<b>Pay Rate </b>: Min $17.84 Mid $20.53
</div></div><br>
<div><div>Position Summary<br>
</div></div><br>
<div><div><p>Demonstrates commitment to the promises, vision, core purpose/mission and goals of LRMC, modeling the values and culture. Works under the supervision of the PFS Supervisor. The AR Follow and Denials Specialist is responsible for collecting payments for outstanding hospital claims, managing accounts, researching denials, submitting corrected claim requests, submitting appeals, and ensuring payments received are reconciled correctly with emphasis place on HIPAA compliance and in accordance with departmental goals, SOP&rsquo;s, and contract terms. Responsible for adhering to all Federal regulations and maintaining current knowledge of all Insurance guidelines. Escalates payer denials trends or claims issues to the PFS Leadership Team to address with the payer. Identifies trends, system issues, and potential process improvements to avoid future delays and denials.<br>
<br>
</p></div></div><br>
<p></p><div><div>Position Responsibilities<br>
</div></div><br>
<div><div><p><b>People At The Heart Of All We Do
</b></p><p></p><ul><li>Fosters an inclusive and engaged environment through teamwork and collaboration.
</li><li>Ensures patients and families have the best possible experiences across the continuum of care.
</li><li>Communicates appropriately with patients, families, team members, and our community in a manner that treasures all people as uniquely created.
</li><li><b>Safety And Performance Improvement
</b><ul><li>Behaves in a mindful manner focused on self, patient, visitor, and team safety.
</li><li>Demonstrates accountability and commitment to quality work.
</li><li>Participates actively in process improvement and adoption of standard work.
</li><li><b>Stewardship
</b></li><li>Demonstrates responsible use of LRH's resources including people, finances, equipment and facilities.
</li><li>Knows and adheres to organizational and department policies and procedures.
</li><li><b>Standard Work: AR Follow Up Denials Specialist
</b></li><li>Actively participates in team development, achieving dashboards, and in accomplishing department goals and objectives
</li><li>Responsible for all aspects of follow up and collections on accounts. This includes making outbound calls to payers and accessing payer websites.
</li><li>Collect payments for outstanding claims and ensure payments received are reconciled correctly.
</li><li>Confirm the claim expected reimbursement information to ensure claims are paid correctly. Follows department&rsquo;s process for follow up on underpayments/overpayments.
</li><li>Research and prepare responses for payor requests for additional information or documentation.
</li><li>Submits corrected claim rebill requests to the PFS Billing team when necessary to send to the insurance payer with correct information and ensures payment is received and claims are paid per contract
</li><li>Research denials and works with other departments such as Coding, Billing, CDM, UM, ect. to resolve denial.
</li><li>Submits the insurance reconsideration/appeals with supporting documentation in a timely manner and follow up with insurance to ensure receipt and processing. Follows insurance payer claims and appeals timely filing guidelines.
</li><li>Communicate clearly and professionally, in both written and verbal manners with internal personnel, payors, providers, patients, and other authorized representatives in regards to outstanding balances.
</li><li>Responsible for adequately working correspondence timely and efficiently (including EOBs, RA&rsquo;s, denial letters).
</li><li>Maintain knowledge of current government and carrier regulations, policies, manuals relevant to the industry.
</li><li>Identify and report trends in carrier payments and denials, which includes documentation of actions taken to resolve issues. Follows internal escalation process when necessary.
</li><li>Identify complex and aged claims issues and follows internal escalation process appropriately.
</li><li>Maintain patient confidentiality and privacy; adheres to HIPAA standards.
</li><li>Organizes job functions and work assignments to be able to effectively complete assignments within established time frames.
</li><li>Must meet department Productivity Guidelines. Works with all areas of the department to assure maximum productivity. Utilizes the PFS Productivity tracker.
</li><li>Demonstrates knowledge of all equipment and systems/technology necessary to complete duties and responsibilities.
</li><li>Other duties, responsibilities, and activities may change or be assigned at any time with or without notice.
</li></ul></li></ul></div></div><br>
<div><div>Competencies &amp; Skills<br>
</div></div><br>
<div><div><p>Essential:<br>
<br>
</p><ul><li>Four years general Patient Accounting experience including understanding of Managed Care contracts and claims analysis. Understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payers and their guidelines. Knowledge of healthcare rules and regulations.
</li><li>An overall understanding of the appeals processes through completion.
</li><li>Ability to read/interpret EOB&rsquo;s
</li><li>Working knowledge of Word, Excel or other Microsoft applications. Good analytical skills for problem solving, typing of 40 WPM and data entry.
</li><li>Knowledge of Accounting Principles; analytical mathematical skills, professional customer service communication skills.
</li><li>Demonstrates accuracy and thoroughness; Meets productivity standards; Completes work in timely manner.
</li><li>Consistently shows ability to recognize and deal with priorities. Adapts to changes in the work environment; Able to deal with frequent change, delays, or unexpected events.
</li><li>Knowledge of HIPAA guidelines.
</li><li>Demonstrates good judgment and reasoning when investigating and solving problems. Good critical thinking skills.
</li><li>Ability to prioritize and manage time effectively.
</li></ul>Nonessential:
<ul><li>Ability to prioritize and manage time effectively.
</li></ul></div></div><br>
<div><div>Qualifications &amp; Experience<br>
</div></div><br>
<div><div><p>Essential:
</p><ul><li>High School or Equivalent
</li></ul>Nonessential:
<ul><li>Associate Degree
 </li></ul>Nonessential:
<p></p><ul><li>Business or Healthcare Administration
 </li></ul>Other information:
<p></p><div>Experience Essential:
<br>
<ul><li>Two years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.
</li></ul><br>
Experience Preferred:
<br>
<ul><li>Four years general patient accounting experience. Experience working with and general understanding of Medicaid, Medicaid Manage Care, Medicare, Medicare Advantage plans, Commercial, Liability, and Workers' Compensation payors.
</li></ul><br>
Certifications Preferred:
<br>
<ul><li>AAHAM or HFMA certification</li></ul></div></div></div></div></div></div><p></p>

AR Follow Up Denials Specialist - Denial & Appeals Mgmt

Wellstar Health System

<div><p>How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.</p><p></p><p><b>
Work Shift</b></p>
Day (United States of America)<p></p><h2 class="jobSectionHeader"><b>
Job Summary:</b></h2>
Under the direction of the Manager of Account Resolution, the Account Resolution Representative II assists with planning and coordinating HB Accounts Resolution follow up activities for an account receivable portfolio of ~ approximately $375M-$500M, including, but not limited to collaboratively working with their Team Lead, Manager, and assisting with training, employees, as circumstances dictate. The Account Resolution Representative II will assist with the development of strategies for establishing a continuous improvement work environment, ensure eligible accounts are reviewed, appealed, escalated or adjusted within the designated payer time frames and are documented appropriately in the patient accounting system. As well as providing educational support in a variety of departmental and individual settings. The role requires data analysis, trending analysis, and educational capabilities regarding payor and revenue cycle business related processes. This role requires a versatile and well developed actionable understanding with demonstrated knowledge of billing, collections, denial management, contractual provision interpretation and provider / payor appeal requirements. In addition to a strong understanding and capability of common business technologies such as MS Office, Excel, PowerPoint, Word and Outlook to perform and communicate the assessment and analysis of multiple acute care and LTAC facility accounts receivable trending and findings is needed. The core role focus of this position is to ensure that accounts are brought final resolution through reimbursement for services and to mitigate financial losses through solid operational execution, development and conformity to defined Policies and Procedures. The Account Resolution Representative II must possess the ability to assist with developing and documenting action plans for quick resource deployment, communicate timely with leadership to understand the specific reasons for payment delays. The role requires the ability to effectively and efficiently communicate both orally and in writing to leadership, multi-task, meet deadlines, adhere to organizational policies and procedures. In addition, the Account Resolution Representative II will assist with additional Revenue Cycle related tasks and duties as assigned.
<h2 class="jobSectionHeader"><b>Core Responsibilities and Essential Functions:</b></h2>
Maintain a working knowledge and perform assigned duties in compliance of all-departmental billing and follow-up policies, procedures, processes and functions. Respond appropriately to inquiries from 3rd parties, insurance providers and patients regarding accounts, collection issues and hospital policies, to insure a minimal Accounts Receivables inventory. * Collect and resolve payments from insurance companies by working with assigned payers and utilizing established policies and procedures. Research and resolve payer rejected/denied claims and analyze accounts for insurance payment accuracy/completeness and for payer claim processing accuracy per contract. Successfully appeal denied accounts and avoid excessive deferred accounts * Demonstrate effective collaboration skills, and support to the follow-Up staff in the performance of their daily functions by assisting with daily planning, organizing, prioritizing and management of workflow, as instructed by leadership. Review account receivables while evaluating trends and tracking recovery efforts by utilizing various departmental tools optimizing individual workflow and process to reduce AR growth, quickly propose solutions to reduce trends, resolve issues, etc. Consistently meet the productivity and quality standards. * Assist staff by providing direction and guidance, creating a team environment through training, recognition, and education which produces optimum work habits and job performance * Assist with setting obtainable short-term goals, maintaining expected level of productivity and quality as defined by policy, or equivalent industry standards when not specifically defined by policy, as well as assisting with performance studies to improve productivity, streamline operations and reduce error rates. Provide assistance with staff training and oversight to ensure that implemented policies and procedures are being followed. Meet deadlines established through interaction with the Manager of Accounts Resolution or other senior leadership. * Review and improve work procedures to ensure that the most productive and efficient methods are used * Monitor progress for assigned workflow on a daily basis, utilizing quantitative technology and tools and providing feedback to leadership regarding success and obstacles to claim resolution * Provide assistance with departmental projects and presentations, as needed. * Maintain and reflect a positive team attitude, regarding any special projects or polices that are implemented by the Revenue Cycle or other senior leadership. * Resolve complaints and misunderstandings in a timely and appropriate manner while demonstrating the ability to tactfully handle difficult situations through an approach that reflects consistency and fairness. * Must maintain a proficiency in the application of, key automated systems that include: Epic, Emdeon Claims Master. * Act as an internal resource; resolving problems and providing expertise to other hospital departments * Review write-off requests, miscellaneous cash adjustments, and submit to manager for approval * Maintain Epic assigned workqueues to ensure timely (7 days or as specified) resolution of review requests. Become cross-trained and fill in for other staff as assigned. * Maintain a working knowledge of WellStar policies and procedures * Maintain membership and active participation in the HFMA professional organization or equivalent, to participate in workshops and classes ensuring a competency level beneficial to the department, as well as to meet minimum requirements in technology advances/applications. * Administrative * Maintain professional relations and convey relevant information to other members of the team within the facility and any applicable vendors Must actively participate and support the efforts of the Revenue Cycle Task Force, Monthly Denials Task Force, Monthly Compliance Coding Partnership as well as other committees as assigned. * Maintain ongoing communication with other PFS and Revenue Cycle departments, keeping the Manager of Accounts Resolution aware of more complex problems and opportunities while maintaining courteous, cooperative, flexible and positive working relationships with all levels of management, employees, physicians, guests and the general public. * Assist with reviewing denial reports and determining significant problems causing rejections and denials; communicate with the leadership of Accounts Resolution the findings and proposes denial prevention solutions * Maintain a working knowledge of relevant legal and compliance issues, including but not limited to HIPAA privacy, Fair Debt &amp; Collection Act guidelines, Medicare &amp; Medicaid regulations and reimbursement methodology, as well as state and federal laws. * Maintain effective communications with legal collection groups, the WellStar Compliance department and other agencies, regarding new and relevant issues must maintain appropriate knowledge and skill sets to read and interpret various regulatory requirements that affect follow-up functions. Maintain appropriate documentation to assure an audit trail of compliance-related activities. * Communicate with and obtain assistance from various type insurance, third party collection, governmental and regulatory agency representatives, in the interpretation of critical regulations and the collection/resolution of patient accounts. Assist with the development, processes and efficiency of Insurance Follow-Up and Denial policies &amp; procedures to ensure they are comprehensive in nature and current/updated. * Consistent review of current processes to ensure compliance with policies and procedures. * Assist with establishing controls and review mechanisms for every procedure to ensure that systems and procedures are being followed correctly * Ensure optimal system capabilities by assisting with staff training, documenting system parameters, challenging systems and obtaining feedback from staff/users. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.
<h2 class="jobSectionHeader"><b>Required Minimum Education:</b></h2><ul><li>
High School Diploma General or GED General</li></ul>
<h2 class="jobSectionHeader"><b>Required Minimum License(s) and Certification(s):</b></h2>
All certifications are required upon hire unless otherwise stated.
<h2 class="jobSectionHeader"><b>Additional License(s) and Certification(s):</b></h2>
Certified Revenue Cycle Representative within 180 Days Preferred
<h2 class="jobSectionHeader"><b>Required Minimum Experience:</b></h2>
Minimum 1 year Experience as an Account Follow-up Representative I or a minimum of two (2) years in hospital patient financial services or related area Required and Must have a thorough understanding of Governmental, i.e. Medicare, Medicaid and / or Non-Governmental, i.e. Commercial: healthcare revenue cycle functions, PFS operations, regulations and reimbursement methodology, denials management, payor technical denial appeals and a proven track record of successful performance within the Revenue Cycle Required
<h2 class="jobSectionHeader"><b>Required Minimum Skills:</b></h2>
Strong interpersonal, mathematical, analytical, computer, problem solving and writing skills, with a take charge attitude. Must be comfortable interacting with insurance providers, physicians and leadership. . Must be able to perform a wide variety of tasks that require independent judgment, ingenuity, and initiative. Competent with MS Word, PowerPoint, and MS Excel is required as critical analysis will be conducted using this technology. Ability to: establish a climate to achieve optimal performance levels and maintain a cohesive work team work efficiently under pressure and deal effectively with constant change operate a computer and related applications apply appropriate supervisory, management and leadership techniques in an operational setting work independently and take initiative demonstrate a commitment to continuous learning deal effectively with difficult people and/or difficult situation willingly accept responsibility and/or delegate responsibility set priorities and use good judgment for self and staff<p></p><p>
Join us and discover the support to do more meaningful work&mdash;and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.</p></div><p></p>

Acct Resolution Rep II

Aultman Health System

<div><div><div><p><b>PURPOSE OF POSITION:</b></p>
<p>The Account Representative has four major areas of responsibility, which are listed below:
</p><div><ul><li>Attend all of AultComp&rsquo;s hearings before the Industrial Commission of Ohio, unless the presence of an attorney is required.
</li></ul><ul><li>Manage the claims of designated self-insured employers.
</li></ul><ul><li>Manage the claims of all state fund employers.
</li></ul><ul><li>Market the services of the TPA, including the group rating program.
</li></ul></div><p>In performing the above tasks, the Account Representative will assist the Claims Coordinator, Clinical Editor, and the Customer with litigation issues, medical bill issues, and claims management issues. The Account Representative will request medical documentation from providers in order to prepare for hearings, schedule independent medical exams, and negotiate lump sum settlements. The Account Representative will also file motions, appeals, objections, lump sum settlement applications, and any other relevant correspondence with the Bureau of Workers&rsquo; Compensation and the Industrial Commission of Ohio, act as a liaison between the Customer and the Manager, and generate administrative billing. A more detailed description of the position is listed below.</p><br>
<p></p>
<p><b>RESPONSIBILITIES &amp; EXPECTATIONS:</b></p>
<ul><li>Prepare docket based upon district, time, issue, and level of hearing.</li>
<li>Attend all hearings in the Akron and Cambridge district offices unless an attorney is requested or there is a time conflict.</li>
<li>Review and prepare all hearing files and distribute to subcontractors when appropriate.</li>
<li>Advise Claims Coordinators regarding the information needed for hearings.</li>
<li>Advise Clinical Editor regarding contested claims so bills are not paid in error.</li>
<li>File appeals, objections, reconsiderations, motions, lump sum settlement applications, and any other correspondence with the Bureau of Workers&rsquo; Compensation and Industrial Commission of Ohio.</li>
<li>Initiate settlement correspondence for self-insured and state fund clients.</li>
<li>Request medical documentation for hearings from attending physicians and any other provider who administered treatment.</li>
<li>Act as account representative for self-insured and state fund employers, advising clients regarding allowance or denial of claims, return to restricted duty, lump sum settlements, extent of disability, allowance or denial of additional conditions, treatment issues, independent medical exams, permanent partial disability objections, and hearing strategies.</li>
<li>Market TPA services to self-insured, state funded, and group rated clients.</li>
<li>Coordinate mailing of group rating material.</li>
<li>Maintain group rating database.</li>
<li>Prepare and mail group rating proposals</li>
<li>Coordinate all correspondence with group administrators.</li>
<li>Generate administrative billing, process payments, and maintain billing database.</li>
<li>Authorize and submit subcontractor&rsquo;s fees to finance for payment.</li></ul><br>
<p></p>
<p></p><ul><li>Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
</li><li>Seeks supervisory guidance/approval as appropriate.</li>
<li>Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.</li>
<li>Promotes and demonstrates professional standards to enhance the development of the department.
</li><li>Practices ethical conduct.</li>
<li>Meets acceptable attendance and punctuality expectations (excluding FMLA)</li>
<li>Reviews the files of self-insured clients to ensure that they are meeting BWC audit requirements.
</li><li>Reviews policies maintained on the Policy and Procedures website that pertain to the position.</li>
</ul>
<p>The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and are not considered a detailed description of all the work requirements that may be inherent to this position.</p><br>
<p></p>
<p>All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity, sexual orientation, age, national origin, disability, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.</p>
<p><b>QUALIFICATIONS:</b></p>
<ul><li>Education: Bachelor&rsquo;s Degree required.</li>
<li>Experience: Knowledge of medical terminology,
</li><li>Mastery of Microsoft Word, Excel and Outlook.</li>
<li>Proficient with basic math skills.
</li><li>Prior employment with a workers&rsquo; compensation third party administrator or the Ohio Bureau of Workers&rsquo; Compensation required.</li></ul><br>
<p>
</p><p><b>WORKING CONDITIONS:</b></p>
<ul><li>Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
</li><li>Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.</li>
<li>Sitting/standing/moving about intermittently during working hours.</li>
<li>Subject to frequent interruptions and changes in priority of duties throughout the day.
</li></ul></div></div><br>
Location: Aultman Health Foundation &middot; AC SELF INS - AULTCOMP TPA<br>
Schedule: Full Time, Day Shift, 8am-5pm</div>

WORKERS COMPENSATION ACCOUNT REPRESENTATIVE

CHRISTUS Health

<div><b>Description</b><p><br>
Summary:</p>
<p>The Patient Access Representative Senior performs duties relating to financial aspects of patient care, including financial counseling, billing and collection of accounts. Additionally, the job duties will include ensuring the hospital maintains compliance with Federal regulations, JCAHO, and Department of Health and Hospital compliance standards, along with communicating directly with patients and families, physicians, nurses, insurance companies and third party payers. The Patient Access Representative Senior also handles difficult patient account management issues escalated by other staff, and assists managers with various other duties as necessary.</p>
<p>Responsibilities:</p><br>
<ul><li>Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.</li><li>
Submits insurance claims to third party payors electronically and on paper. Follows up on unpaid third party claims to resolution (payment or denial).</li><li>
Evaluates and processes accounts for adjustments, charity, outside assistance or bad debt. Analyzes accounts to ensure full reimbursement and to satisfy patient and/or insurance company inquiries.</li><li>
Collects balances due from patients using phone calls, personal contact, statements, letters or third party services.</li><li>
Receives, processes and responds to correspondence or phone inquiries from patients, guarantors, insurance companies, attorneys, etc.</li><li>
Compiles data, tracks results and reports to management.</li><li>
May be assigned specialty responsibilities in the areas of refunds, reconciliation, balancing and/or posting and in data collection and analysis.</li><li>
Handles difficult patient account management issues referred by other staff.</li><li>
Supports the department in achieving established performance targets.</li><li>
Takes personal responsibility to ensure compliance with all policies, procedures and standards as promulgated by state and federal agencies, the hospital, and other regulatory entities.</li><li>
Performs all duties in a manner that protects the confidentiality of patients and does not solicit or disclose any confidential information unless it is necessary in the performance of assigned job duties.</li><li>
Assists managers with various duties including, but not limited to, review of write-offs, adjustments, refunds and discounts; coordinating work group activities; and training of other staff.</li></ul>
<p>Job Requirements:</p><br>
<p><b>Education/Skills</b></p>
<ul><li>High School Diploma or equivalent experience preferred</li></ul>
<p><b>Experience</b></p>
<ul><li>3-5 years of experience preferred</li></ul>
<p><b>Licenses, Registrations, or Certifications</b>
</p><ul><li>None required</li></ul><br>
<p></p>
<p>Work Schedule:</p><br>
<p>4 Days - 10 Hours</p>
<p>Work Type:</p><br>
<p>Full Time</p></div>

Patient Access Representative Senior - Admitting

NuStart Consulting

<div><p>Position: Claims Resolution Representative (DME)</p>
<p>
Overview</p>
<p>
The Claims Resolution Representative is responsible for identifying, correcting, and resolving DME claims that were billed inaccurately due to coding errors, payer discrepancies, or incorrect insurance information. This role ensures claims are properly corrected, rerouted to the appropriate payer, and successfully reimbursed. Complex denials requiring further review are escalated to the Appeals team.</p>
<p>
Key Responsibilities</p>
<ul><li>Analyze claims to determine root cause of misrouting or denial (e.g., incorrect payer, coding errors, eligibility issues)</li></ul>
<ul><li>Verify and update patient insurance information, including coordination of benefits (COB)</li></ul>
<ul><li>Review and validate coding accuracy (ICD-10, HCPCS, CPT as applicable)</li></ul>
<ul><li>Correct claim errors and ensure all required documentation is in place prior to resubmission</li></ul>
<ul><li>Resubmit corrected claims to the appropriate payer in a timely and accurate manner</li></ul>
<ul><li>Identify trends or recurring issues in claim errors and contribute to process improvement</li></ul>
<ul><li>Monitor claim status post-resubmission and follow up on pending or unresolved claims</li></ul>
<ul><li>Escalate complex denials or unresolved issues to the Appeals team as appropriate</li></ul>
<p>
Qualifications</p>
<ul><li>Previous experience in within DME preferably with Surgical Dressings, Ostomy, Urological, Tracheostomy, etc.)</li></ul>
<ul><li>Strong understanding of Medicare guidelines, LCDs, and compliance requirements</li></ul>
<ul><li>Proficiency with medical billing systems and electronic claims submission platforms</li></ul>
<ul><li>Working knowledge of ICD-10, HCPCS, and CPT coding</li></ul>
<ul><li>Familiarity with CMS-1500 (professional claims)</li></ul>
<ul><li>Understanding of payer guidelines, claim frequency codes, and resubmission processes</li></ul>
<ul><li>High attention to detail with strong organizational and problem-solving skills</li></ul>
<ul><li>Strong communication skills and ability to work independently and within a team</li></ul>
<ul><li>Experience with Brightree is highly preferred</li></ul>
<ul><li>Minimum typing speed of 60 WPM</li></ul></div>

Claims Resolution Specialist

Top Line Resource Group (TLRG)

<p><b>Location:</b> DHA Phase 8, Lahore [Onsite]</p><p><b>Employment Type:</b> Full-time</p><p><b>Work Timing:</b> 05PM &ndash; 02AM Pakistan Time</p><p><b>Job Overview</b></p><p>Topline Resource Group (TLRG) is seeking a highly experienced and results-driven <b>Revenue Cycle Management (RCM) Specialist </b>to oversee operations for multiple healthcare clients across different states.</p><p>The ideal candidate will have extensive experience managing the <b>end-to-end medical billing revenue cycle</b>, including insurance verification, coding review, claims submission, payment posting, accounts receivable follow-ups, and denial management.</p><p><b>Key Responsibilities</b></p><p>Oversee and manage <b>end-to-end Revenue Cycle Management operations</b> for multiple healthcare provider clients.</p><p>Supervise and support internal RCM teams handling:</p><ul><li>Insurance Verification (VOBs)</li><li>Prior Authorizations</li><li>Medical Coding Review</li><li>Charge Entry</li><li>Claims Submission</li><li>Payment Posting</li><li>Accounts Receivable (AR) Follow-ups</li><li>Denial Management</li></ul><p>Monitor <b>claim lifecycle performance</b>, ensuring accurate and timely claim submissions and reimbursements.</p><p>Analyze <b>EOBs, ERAs, and payer remittance reports</b> to identify trends in denials, underpayments, and claim rejections.</p><p>Communicate directly with <b>US insurance payers and client representatives</b> to resolve complex billing issues.</p><p>Ensure compliance with <b>payer policies, CMS regulations, and HIPAA guidelines</b>.</p><p>Develop and implement <b>process improvements</b> to increase collection rates and reduce AR aging.</p><p>Track and manage <b>KPIs including AR aging, denial rate, clean claim rate, and reimbursement turnaround time</b>.</p><p>Provide <b>training, mentorship, and performance management</b> for RCM staff.</p><p>Coordinate with internal departments including <b>coding, billing, compliance, and client services</b> to ensure seamless revenue cycle operations.</p><p>Maintain accurate documentation and reporting for <b>client performance metrics and operational updates</b>.</p><p><b>Required Qualifications</b></p><ul><li>Bachelor&rsquo;s degree in Healthcare Administration, Business, or a related field preferred.</li><li><b>5+ years of experience in Medical Billing and Revenue Cycle Management.</b></li><li>Minimum <b>2 years of experience in a supervisory or team lead role within an RCM environment.</b></li><li>Strong knowledge of the <b>complete medical billing lifecycle.</b></li></ul><p>Expert-level familiarity with:</p><ul><li>CPT Codes</li><li>ICD-10 Codes</li><li>HCPCS Codes</li><li>Claim submission workflows</li><li>Denial management processes</li></ul><p>Experience working with <b>multiple payers including Medicare, Medicaid, and Commercial insurance plans.</b></p><p>Hands-on experience with <b>EHR/EMR and Practice Management systems.</b></p><p>Strong analytical and problem-solving abilities for <b>resolving complex claim and reimbursement issues.</b></p><p>Excellent <b>verbal and written English communication skills</b> for interacting with US clients and payers.</p><p>Ability to manage <b>high-volume workloads while maintaining accuracy and compliance</b>.</p><p><b>Preferred Skills</b></p><p>Prior experience managing <b>multiple US healthcare provider accounts across different states.</b></p><p>Experience working in <b>US healthcare BPO or medical outsourcing environments.</b></p><p>Familiarity with <b>payer-specific billing guidelines and state-based insurance requirements.</b></p><p>Strong leadership skills with the ability to <b>build and manage high-performing RCM teams.</b></p><p>Experience with <b>performance reporting, operational dashboards, and AR analytics.</b></p><p>Knowledge of <b>HIPAA compliance, CMS regulations, and payer audit requirements.</b></p><p>Application Question(s):</p><ul><li>We are looking to hire immediately, are you available to join immediately?</li></ul><p>Experience:</p><ul><li>RCM: 4 years (Required)</li></ul><p>Work Location: In person</p>

Revenue Cycle Management (RCM) Manager

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