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100% Remote!
Pay: $18-22/hour
We are looking for candidates who have experience working claims related to PACE programs offered for senior patients. PACE is an all-inclusive program that provides all the care and services needed to help patients continue living in the community. These patients are usually dually eligible for Medicare and Medicaid, and there's a monthly cap on the benefits.
Our team assists healthcare providers and hospital entities with the remediation of 3rd party accounts receivable and a variety of revenue outsource capabilities. The primary role is to resolve assigned accounts by following up with commercial and government payers on denied, underpaid, or otherwise unresolved accounts and collecting insurance claim balances for the client. This position will require in-depth research and problem solving to get the resolution on these claims, while maintaining productivity and quality outputs for the assigned client.
Some of the additional benefits you will have working with us include:
- Permanent position
- Flex Schedule
- Excellent Health, Dental, Vision, Life Packages
- PTO, paid sick leave, paid holidays
- Opportunity for career growth
Responsibilities:
- Performs second-tier account follow-up activities in accordance with organizational, client and regulatory guidelines for outstanding insurance receivables including, but not limited to:
- Performing account follow-up activities on high-dollar accounts receivable
- Research items requiring further assistance
- Possesses an understanding of the healthcare revenue cycle and applies this knowledge to assist team with achievement of quality control standards
- Demonstrates the ability to professionally communicate with colleagues, payers, and clients (if necessary)
- Ensures accurate and complete account follow-up by demonstrating a thorough understanding of carrier-specific reimbursement as applicable to claim processing to include: eligibility discrepancies, UB-04 and/or 1500 claims form review, DRG, per diem, case rate, fee schedule reimbursements, etc.
- Identifies and communicates A/R trends, payer behavior, workflow inconsistencies or other barriers to account resolution to team and engagement leadership
- Researches and documents any correspondence received related to assigned accounts
- Assess accounts for balance accuracy, confirm correct payer billed, coding accuracy, denials, and outstanding insurance requests
- Provide documentation appropriately and submit corrections; or if payer error, escalate for re-processing in a professional and timely manner
- Identify billing or coding issues and requests re-bills, secondary billing, or corrected bills as needed
- Contacts third party payers and government agencies to resolve outstanding account balances
- Maintains departmental productivity and quality standards
- Must possess general PC aptitude and keyboarding ability -- must be able to type at a minimum of 40 wpm required
- Ability to multitask in several applications and systems simultaneously and demonstrates competency with Microsoft Suite and assorted internet browsers required
Education and Experience:
- A minimum of 1-2 years in Healthcare Provider Revenue Cycle experience required
- High School Diploma or equivalent required; Associate's or Bachelor's Degree preferred
- Hands-on experience using Epic, Cerner, Invision, Soarian, McKesson, Allscripts, Meditech, and other industry recognized Revenue Cycle Management Systems required
- Hands-on knowledge of UB-04 and/or HCFA 1500 billing and account follow up, CPT and ICD-10 coding and terminology for hospital and/or ambulatory/physician billing
Physical Requirements:
- While performing the duties of this job, the employee is frequently to use hands, fingers; and frequently to talk or hear. The employee must exert up to 15 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or up to 5 pounds of force frequently, and/or a negligible amount of force constantly to move objects. The employee must have the ability to sit for long periods of time.
TRC Talent Solutions is proud to be an Equal Opportunity Employer (EOE). All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
