Must be able to understand and read the Explanation of Benefits (EOB).  Review all open charges for non-payment, short payment ineligibility, inaccurate diagnoses, no authorizations, etc. Responsible for tracking and reviewing evidence of benefits/EOB’s indicating payment or denying of services. Responsible for appealing all of the unpaid and denied claims received. Complete all corrections in CareLogic and document process. Communicate effectively with Supervisor to address processing issues. Run A/R reports weekly and prepare appeals to payers. Prepare documentation to support findings and escalate all denial trends and key issues to Supervisor. Demonstrate knowledge and skills necessary to provide appropriate service to consumers with regards to account collections, for consumers with coverage by more than one insurer, prepare and submit secondary insurance claims and manage coordination of benefits. Answer consumer billing questions and work directly with subscriber to obtain valid insurance information such as insurance benefit card, authorization, and billing contact information. Attend workshops and trainings. 

 

Hours:

Full Time

 

This is a Full Time Benefited position with the following benefits:

3.2 weeks of Paid Time Off during the first year Medical insurance, vision, dental and life insurance benefits 403(b) employee participation and employer match Tuition Reimbursement after 1 year of employment 9 Agency-paid holidays