This position receives/responds to provider inquiries on claim issues, researching information by reviewing plan, eligibility, and authorizations to determine appropriate resolution. Recommends solutions by working with CSC or RCM to identify areas of opportunity, also completes special assignments and analyzes provider requests while assisting other departments and interacting directly with providers.
The Scheduling Outreach Specialist is responsible for conducting emergency department, wellness, or preventative service outreach calls to identified patients. This role will provide patient education about clinic appointment availability and identify and communicate if the patient has any care coordination or triaging needs from the supported practice.
The Revenue Specialist, Denials serves as the point of contact between major client contacts and the denial appeal process with the relevant payer. Responsible for the first denial audit and actions to fix outstanding claims. This position entails handling patient health information (PHI) while upholding strict privacy and security standards concerning confidential and proprietary data.