Responsibilities:
Maintain accurate and timely completion of daily follow-up or denial account assignment.
Identify and analyze underpayments to determine reasons for discrepancies and process denials and appeals as needed.
Review posted payments and adjustments to ensure accuracy.
Analyze EOBs to ensure proper reimbursement.
Conduct relevant research to complete the appeals process, including assessing accurate documentation, tracking, responding to, and resolving appeals with third‐party payers in a timely manner.
Communicate with payers on outstanding claims, resolve payment variances, and achieve timely reimbursement.
Document all activity on patient accounts.
Collaborate with internal departments and external organizations to ensure correct reimbursement and resolve appeals.
Monitor underpaid and denied claims for trends, identify root causes, and report findings to supervisor.
Observe best‐practice processes in follow‐up and customer service activities.
Participate in staff training that aligns with recognized improvement opportunities and increases understanding of Medicare/Medicaid requirements and general follow‐up processes.
Act in accordance with LCMC Health's mission and values, serving as a role model for ethical behavior.
Adhere to federal and state regulations related to the protection of patient information, such as HIPAA and facility‐specific guidelines.
Qualifications:
High school diploma or GED, or appropriate work experience in healthcare, particularly in billing, collections, payment processing, or denial management.
Working knowledge of the revenue cycle from a hospital billing perspective.2–3 years of hospital billing and collections experience.
Experience managing Managed Medicare accounts within a hospital or healthcare revenue cycle environment.
Understanding of Medicare Advantage payer guidelines.
Familiarity with inpatient and outpatient hospital billing requirements.
Proven ability to resolve claim denials, underpayments, and billing edits with insurance payers.
Ability to interpret EOBs, remittance advice, and payer correspondence to identify and resolve payment discrepancies.
Knowledge of UB‐04 billing, revenue codes, DRG/APC reimbursement methodologies, and medical necessity requirements.
Experience with appeals, reconsiderations, and payer escalation processes.
Strong analytical, organizational, and follow‐up skills.
Ability to manage high‐volume workloads and meet productivity expectations.
Excellent written and verbal communication skills, with the ability to effectively interact with payers and internal stakeholders.
Work ShiftDays (United States of America)
Equal Opportunity Employer StatementLCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.
