Insurance Follow-up Denial Specialist I

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🕒 April 29

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Optim Health System

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1976

🧘 Wellness

👥 B2C

Wellness • B2C

Optim Health System is a regional health system operating hospitals, ambulatory surgery centers, and clinics that specialize in orthopedic care, interventional pain management, neurosurgery, and primary care. The system emphasizes patient-focused, high-quality, and compassionate care, offering Centers of Excellence for joints, spine, and other musculoskeletal services, as well as imaging, rehabilitation, and surgical services across community hospitals and outpatient facilities.

📋 Description

• Protects the financial standing of Optim Health by performing functions related to the billing, coding verification, collection, payment, and customer service for all payer and patient accounts. • Under general supervision, is responsible for processing insurance and billing insurance in a timely manner. • Reviews assigned electronic claims and submission reports. • Resolves and resubmits rejected claims appropriately as necessary. • Works closely with Medical Records, Coding, Revenue Integrity, Patient Access, and Patient Financial Services departments to resolve outstanding claim errors by obtaining necessary information for accurate billing. • Processes daily error logs, stalled reports, aging claims, and any ah-hoc reports. • Addresses claim issues from insurance companies requesting additional information and/or checking status of billings. • Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all. • Initiates next billing, assign appropriate follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate. • Sends initial or secondary bills to Insurance payers. • Documents billing, follow-up and/or assign collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary. • Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims with the oversight of the Supervisor and/or Manager.

🎯 Requirements

• Able to work with advanced billing procedures. • Able to prioritize and multitask based on volume of work within specific deadlines. • Knowledge of the Revenue Cycle and the links between departments: Charge Capture, Patient Access, HIM, Coding, and Patient Financial Services. • Working knowledge involving coverage, payment, compliance, and basic billing rules for Government and Managed Care payers. • Uses discretion when discussing personnel/patient related issues that are confidential in nature. • Ability to give and follow written and verbal directions. • Working knowledge of personal computer applications and proficient in word, excel and power point applications. Self-motivator, quick thinker, communicates professionally and effectively in English, both verbally and in writing. • Ability to work with all departments and all levels of management. • One-year of experience in Revenue Cycle Department or related areas such as registration, finance, collections, customer service, medical, or contract management. • High school diploma or GED.

🏖️ Benefits

• Adheres to all company policies and procedures. • Adheres to Optim Health Compliance Plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.