Coordinating payor denial and appeal follow up activities to ensure timely response from third party payors.
Communicating and coordinating with various individuals/distributions and assisting with monitoring of the day to day activities related to appeal follow up and denials.
Maintaining the hospital tracking tool/application that stores/communicates all denial and review activity.
Resolve aged claims and appeals via payer portals & outbound phone calls.
Prioritize assigned work queue to ensure timely work is balanced with working the most payable claims.
Work professionally with Revenue Cycle teammates to be responsive to requests that require your assistance.
CareDx, Inc. is focused on providing healthcare solutions for transplant patients and caregivers. They are the leading provider of genomics-based information for transplant patients.
Perform pre-call analysis and check the status by calling the payer or using IVR or web portal services.
Maintain adequate documentation on the client software to send the necessary documentation to insurance companies and maintain a clear audit trail for future reference.
Record after-call actions and perform post-call analysis for the claim follow-up.
TruBridge connects providers, patients, and communities with innovative solutions that create real value by supporting both the financial and clinical sides of healthcare delivery. They are a remote team that encourages their employees to push boundaries and look at things differently.
Serve as the vendor’s lead clinical subject matter expert on clinical denials management and prevention.
Partner with provider clients to design and implement best practices for denial prevention and appeal workflows.
Conduct complex clinical case reviews for DRG validation, identifying and defending clinically appropriate DRG assignments.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations. They leverage over 24 years of expertise and their E360 RCM ™ platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers. EnableComp is a multi-year recipient of the Top Workplaces award recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024.
Submitting clean claims efficiently and accurately for your assigned clinics
Following up on denials and rejections with urgency and clarity
Posting payments, reconciling accounts, and communicating proactively with clinics
Jane is a founder-led, high-growth SaaS company. They build products and tools that thousands of clinics rely on every day to run their businesses, care for their patients, and grow their communities, with over 700 employees working remotely across Canada, the US, and the UK.
Maintain a working knowledge and understanding of DMEOPS CPT and ICD-10 codes.
Utilize the company billing and collections system to identify and resolve any claims that have been unpaid, short paid and/or denied.
Review EOB's and other correspondence from insurance companies for correct reimbursement according to rules and regulations and contract terms.
Hanger, Inc. is the world's premier provider of orthotic and prosthetic (O&P) services and products, offering the most advanced O&P solutions, clinically differentiated programs and unsurpassed customer service. They have 160 years of clinical excellence and innovation, and its vision is to lead the orthotic and prosthetic markets by providing superior patient care, outcomes, services and value.
Under the direction of the Patient Accounts Manager, the Patient Accounts Specialist is involved in medical billing and follow-up.
Participates in training and auditing of Patient Account Representatives.
Identifies delinquent accounts to expedite resolution.
Kettering Health is a not-for-profit system of 13 medical centers and more than 120 outpatient facilities serving southwest Ohio. They are committed to transforming the health care experience with high-quality care for every stage of life.
Accurately review denied claims to identify root causes.
Communicate directly with insurance representatives to negotiate settlements.
Monitor denial trends and provide actionable feedback to billing and clinical teams.
Mindoula is a healthcare organization. They are seeking an Account Receivable Representative and value candidates with strong communication and problem-solving skills.
Develop operational processes that align with revenue cycle management best practices aiming to maximize reimbursement
Lead a team of managers and individual contributors that will own various claim edit, general follow-up, and denial management tasks with various payers
Identify trends in payer behavior and surface them for leadership review
BetterHelp's mission is to remove traditional barriers to therapy and make mental health care more accessible. Founded in 2013, they are the world’s largest online therapy service with over 30,000 licensed therapists.
Performs daily billing functions for assigned Accounts Receivable claims to ensure claims resolutions within set deadlines.
Sends out daily appeals to insurance companies for denied claims to maintain consistent cash flow of assigned A/R.
Resolves incoming correspondence or telephone inquiries in a timely manner in accordance with payer deadlines.
CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually, employing over 157,000 employees across 24 states.
Maintains the practice management system by entering accurate data, verifying and updating insurance and claims information, handles carrier correspondence, manages EOBs, and keys payments received into the system.
Prepares, reviews, submits, and follows up with clean claims to various companies/individuals.
Collects, posts, and manages patient account payments.
US Anesthesia Partners provides comprehensive anesthesia care. They are committed to clinical excellence and outstanding patient experience.
Serve as the authoritative SME on technical CARC/RARC codes, mapping, and workflows.
Define product requirements for auto-scrub, intelligent resubmission, documentation-request automation, and worklist prioritization for soft denials.
Design root-cause prevention logic that feeds denial patterns upstream to SmarterPrebill, SmarterUM, and Patient Access.
Smarter Technologies is a healthcare technology company focused on transforming how healthcare services are delivered, managed, and reimbursed. They bring together Access Healthcare, SmarterDx, Thoughtful AI, and Pieces, combining deep healthcare services expertise with advanced data, automation, and AI capabilities.
Contacts insurance companies for status on outstanding claims.
Processes and follows up on appeals to insurance companies.
Works outstanding accounts receivable from assigned work queues.
US Anesthesia Partners is dedicated to providing high-quality anesthesia services. They offer equal employment opportunities to all employees and applicants.
Review, analyze, and estimate reimbursement across clinical, technical, and DRG‑related denials.
Conduct daily client transaction reviews and calculate expected payments and Corro reimbursement.
Identify payer and referral trends, monitor denial patterns, and support appeal strategies.
CorroHealth aims to help clients exceed their financial health goals by providing scalable solutions and clinical expertise across the reimbursement cycle. They enable their teams with leading technology and believe in investing in their employees' professional development and personal growth.
Responsible for collecting and verifying demographic, guarantor and insurance information, educate patients, physicians, staff, etc. on the financial process.
Will be involved in extensive utilization of the Hospitals revenue systems and constant interaction with patients, physicians, insurance companies, donors and other members of the Hospitals' staff.
Advise and counsel patients and guarantors regarding patient rights, responsibilities and procedures as it relates to payment for Hospital and ProFee care
They are a comprehensive academic medical center. They have many employees and maintain a collaborative culture.
Processes acute and post-acute inpatient medical and select intensive outpatient higher level of care requests through clinical review.
Interprets and applies InterQual criteria, CMS-issued guidelines, Capital Blue Cross Medical Policies to requests.
Collaborates with UM department staff and Medical Directors to make a final determination, and with Care Management staff on discharge planning.
Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association. At Capital, employees work alongside a caring team of supportive colleagues and are encouraged to volunteer in their community.
Responsible for accurate and timely submission of billing claims.
Responsible for the timely follow-up of unpaid inpatient, outpatient and clinic claims.
Provides appropriate medical documentation to the insurance carrier.
Plumas District Hospital provides essential health care services to the residents of Quincy and the surrounding area. They are located in Quincy, California, nestled against the Western slope of the Sierra Nevada mountain range.
Auditing to ensure new provider and care center information is accurate.
Conducting Care Center audits based on the number of providers.
Identifying, monitoring, and managing denial management trends.
Privia Health is a technology-driven, national physician enablement company. They collaborate with medical groups, health plans, and health systems to optimize physician practices and improve patient experiences. Their platform is led by industry talent and cloud-based technology.