Revenue Cycle Specialist- Denials

Stamford Health is a well-established, award winning Healthcare System with multiple locations in CT.

As a new Certified Great Place to Work organization, Stamford Health understands what it takes to attract talent in order to improve our workforce and support our mission, to that end we offer :

• Competitive salary
• Sign on bonuses for designated positions
• Comprehensive, low-cost health insurance plans available day one
• Wellness programs
• Paid Time Off accruals
• Tax deferred annuity and (403b) pension plan
• Tuition reimbursement
• Free on-site parking and train station shuttle
• Childcare partnership with Children’s Learning Center
• The Revenue Cycle Specialist- Denials is responsible for researching, resolving, and resubmitting denied claims; taking timely and routine action to collect unpaid claims;

and interpreting various forms of explanations of benefits (EOBs) from insurance carriers

• Understands and interprets insurance Explanations of Benefits (EOBs), knowing when and how to ensure that maximum payment has been received.
• Researches and resolves rejected, incorrectly paid, and denied claims within an established time frame.
• Researches and resolves unpaid accounts receivable and makes any corrections in medical group’s practice management system necessary to ensure maximum reimbursement for all services rendered.
• Resubmits claim forms as appropriate.
• Professionally responds to all billing-related inquiries from patients, staff, and payers in a timely manner.
• Utilizes available resources to identify reasons for payment discrepancies.
• Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
• Accurately documents patient accounts of all actions taken.
• Communicates with clinic management and staff regarding insurance carrier contractual and regulatory requirements.
• Educates clinic management and staff regarding changes to insurance and regulatory requirements.
• Actively participates in practice management and payer meetings.
• Accurately documents patient accounts of all actions taken.
• Establishes and maintains a professional relationship with all SHMG staff in order to resolve problems and increase knowledge of account management.
• Maintains standards set by management.
• Apprises management of concerns as appropriate.
• Informs management, as appropriate, regarding backlogs and time available for additional tasks.
• As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
• Completes additional projects and duties as assigned.
• Associate’s degree or medical billing certification preferred. CPC preferred.
• 3+ years of experience working in a multispecialty group practice, healthcare system with an ambulatory focus, or academic medical center.
• 3+ years of experience working with a medical office / hospital accounts receivable system.
• Extensive knowledge of insurance payer reimbursement, collection practices, and accounts receivable follow-up.
• Demonstrates overall knowledge of claims processing for various insurances, including private and governed.
• Comprehensive knowledge of ICD-10, CPT, and HCPCS coding.
• We are committed to building an inclusive workplace that values diversity and inclusion and reflects the diversity of the community and patients we serve.
30+ days ago