Claims Escalation & Denials Appeals Specialist

This is a fully remote position, open to applicants in Idaho.

📋 Description

• Carry out collection efforts to ensure the receipt of medical claims within twenty-eight (28) days.

• Initiate outbound calls to insurance providers and utilize payer portals for resolving claims issues.

• Collaborate with insurance companies to guarantee prompt payment for services provided.

• Adhere to billing and collection protocols to ensure precise and timely reimbursements.

• Analyze accounts receivable accounts to identify payer-related issues that may cause payment delays.

• Reach out to payers to clarify denials and identify necessary changes for payment processing.

• Prepare appeals when claim denials result from payer errors.

• Record all communications with payers in the billing system.

• Partner with Utilization Review for prior authorization and medical necessity documentation.

• Maintain accurate records of patient billing and payment transactions.

• Generate management reports detailing outstanding balances and collections activities.

• Collaborate with the Revenue Cycle Management (RCM) team and other departments.

• Keep up-to-date with Northpoint billing and reimbursement requirements as dictated by each payer.

• Comply with company policies, procedures, confidentiality mandates, and HIPAA regulations.

• Perform additional job-related duties as assigned.

⛳️ Requirements

• A minimum of 2 years' experience in collections, billing reimbursement, payer relations, or medical Accounts Receivable is required.

• Preferred experience in a healthcare or behavioral health system with multiple levels of care.

• Familiarity with commercial medical insurance billing, Medicaid, claims submission, and the technical aspects of billing software is essential.

• Experience with all-in-one practice management, clearing house, and billing software is required.

• Proficient in navigating payer portals effectively.

• Must have proficiency in CPT, HCPCS, and ICD-10 codes, as well as data entry for various third-party billing and payers, including their reimbursement and denial patterns.

• Knowledge of insurance guidelines, including HMO/PPO, Medicare, Medicaid, and other payer systems is necessary.

• Experience with KIPU or similar EHR/EMR systems is preferred.

• Strong problem-solving skills to investigate and resolve discrepancies, denials, appeals, and collections issues.

• Familiarity with major payer guidelines is beneficial.

• Proficient in Microsoft Office Suite.

• Excellent organizational skills, ability to multitask, prioritize, pay attention to detail, and work both independently and as part of a team.

• Capability to maintain confidentiality in line with established policies, procedures, HIPAA, and standards of care.

🏝️ Benefits

• Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s).

• 100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000.

• 100% Employer Paid Employee Assistance Program.

• Voluntary options for Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance.

• Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses.

• Generous Paid Time Off plan.

• Employee Referral Bonuses.

• 401K Retirement Plan with Employer Match.