Investigates health plan denials, corrects and rebills claims, prepares and monitors payer appeals, adjusts appropriate denials, and coordinates resolution across departments. Maintains denial records, identifies recurring denial patterns, and produces quarterly reports. Requires professional billing experience, knowledge of healthcare payers and reimbursement systems, medical coding terminology, problem-solving ability, and ten-key proficiency.
Wage Range: $21.52 - $34.43 per hour
Posted wage ranges represent the entire range from minimum to maximum. For jobs with more than one level, the posted range reflects the minimum of the lowest level and the maximum of the highest level. Some positions also offer additional premiums based on shift, certifications or degrees. Job offers are determined based on a candidate's years of relevant experience, level of education and internal equity.
Job Summary:
Investigates health plan denials to determine appropriate action and provide resolution.
Primary Duties:
1. investigates insurance denials to identify action necessary.
2. Corrects claims based on denials, complaints and audits and rebills using payor approved process.
3. Determines need for payor appeal and sends individualized appeal letter. Monitors appeals for resolution
4.. Adjusts denials determined to be appropriate using the corresponding adjustment code(s).
5. Works the accounts that meet denial management criteria and coordinates resolution with other departments. Denial management criteria include accounts that have potential financial impact such as authorization and refer denials, bundling issues and medical necessity for all assigned payers.
6. Logs all denials including actions and resolution on Denial spreadsheet.
7. Identify denial pattern to identify potential process improvement.
8. Produces quarterly denial reports.
License, Certification, Education or Experience:
REQUIRED for the position:
• High School graduate or equivalent.
• 1-year previous experience in professional billing.
• Knowledge and experience in working with health care insurers and their reimbursement systems, especially Medicare, Medicaid, Workers Compensation, Motor Vehicle and contract payers.
• A good understanding of CPT, Modifiers, HCPC, ICD-10 codes and medical terminologies.
• Demonstrated problem solving ability.
• Ten-key by touch
DESIRED for the position:
• College degree/Vocational training in billing or business
Benefit Information:
Choices that care for you and your family
At EvergreenHealth, we appreciate our employees’ commitment and contribution to our success. We are proud to offer a suite of quality benefits and resources that are comprehensive, flexible, and competitive to help our staff and their loved ones maintain and improve health and financial well-being.
- Medical, vision and dental insurance
- On-demand virtual health care
- Health Savings Account
- Flexible Spending Account
- Life and disability insurance
- Retirement plans (457(b) and 401(a) with employer contribution)
- Tuition assistance for undergraduate and graduate degrees
- Federal Public Service Loan Forgiveness program
- Paid Time Off/Vacation
- Extended Illness Bank/Sick Leave
- Paid holidays
- Voluntary hospital indemnity insurance
- Voluntary identity theft protection
- Voluntary legal insurance
- Pay in lieu of benefits premium program
- Free parking
- Commuter benefits
View a summary of our total rewards available to you as an EvergreenHealth team member by clicking on the link below.
Kirkland Employee Benefits | Kirkland, WA | EvergreenHealth
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