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Role Description

RAYUS Radiology is looking for an Insurance Denials Specialist to join our team. As an Insurance Denials Specialist, you will investigate and determine the reason for a denied or unpaid claim, and take necessary steps to expedite the medical billing and collections of the accounts receivable. This is a full-time fully remote position working 40 hours per week; shifts are 8:00am - 5:00pm.

• Insurance Denial Follow-up (85%):
  • Accurately and efficiently reviews denied claim information using the payer's explanation of benefits, website, and by making outbound phone calls to the payer's provider relations department for multiple denial types, payers, and/or states.
  • Reviews and obtains appropriate information or documentation from claim re-submission for all denied services, per insurance guidelines and requirements.
  • Communicates with patients, insurance carriers, co-workers, centers, markets, referral sources, and attorneys in a timely, effective manner to expedite the billing and collection of accounts receivable.
  • Documents all communications with coworkers, patients, and payer sources in the billing system.
  • Contributes to the steady reduction of the days-sales-outstanding (DSO), increases monthly gross collections, and increases percentage of collections.
  • Prioritizes workload, concentrating on "priority" work which will enhance bottom line results and achievement of the most important objectives.
  • Contributes to a team environment.
  • Recognizes and communicates trends in workflow to departmental leaders.
  • Meets or exceeds RCM Quality Assurance standards.
  • Ensures timely follow-up and completion of all daily tasks and responsibilities.
• Staff Support (10%):
  • Assists in the mentoring and training of new Insurance Denials Specialists.
  • Recommends and assists in implementing new approaches and ideas for improvement in processes and workflows.
  • Serves as a resource for Insurance Denials Specialists.
  • Acts as department go-to resource for team and others in Lead or Manager's absence, as assigned.
• Other Duties (10%):
  • As backup for customer service team, communicates and responds to customer inquiries as needed.

Qualifications

• High School diploma or equivalent.
• 4+ years' experience in a medical billing department, prior authorization department, or payer claim processing department, or 2+ years' experience as Insurance Denials Specialist within the organization.
• Intermediate proficiency with Microsoft Excel, PowerPoint, Word, and Outlook.
• Proficient with using computer systems and typing.

Requirements

• Graduate of an accredited medical billing program (preferred).
• Bachelor's degree strongly preferred.
• Knowledge of ICD-10, CPT, and HCPCS codes.

Benefits

• Medical, dental, and vision insurance.
• 401k with company match.
• Life and disability insurance.
• Tuition reimbursement.
• Adoption assistance.
• Pet insurance.
• PTO and holiday pay.
• Many more benefits based on eligibility.