Payment Recovery Specialist, Out of State Billing, Remote

Role Summary:

The OOS Team works with facilities across the US to process their Out of State Medicaid claims. We focus on hospital billing and follow up, hospital and physician enrollment, as well as eligibility verifications.  The Payment Recovery Specialist follows-up on claim status, review payer responses, and assists with denial management. The Payment Recovery Specialist coordinates with departments and insurance companies to ensure follow-up on all appeals, claim payments, and denials, bringing claims to resolution. Their efforts help dictate the workflow of accounts to other team members as needed for account resolution. Team members will work with other members of the Out of State Medicaid Division to interpret eligibility, discern remittance advance and determine next steps for the life of the claim (payment posting, appeal, corrections, etc.). 

Role Responsibilities:

• Resolves billed claims and referred denials
• Manage assigned work queues
• Performs contact with payers via phone calls and payer portals
• Documents related claim status activity
• Communicates pertinent payer trends to the Team Leader
• Review payment accuracy
• Upload copies of claim status and remits as needed
• Accountable for meeting established productivity measures and goals
• Participate in departmental meetings
• Prioritize workload based on follow up date, dollar amount, hospital request, aging, etc.
• Identify Medicaid Payor trends and issues and communicate to Team Lead/Service Line Manager
• Identify denied line items and take necessary steps with the payor to resolve the account
• Document findings and status within the system, using established department noting guidelines
• Follow up on accounts in a timely manner consistent with established team procedures
• Work together within assigned groups to determine next steps on the life of claim

Role Requirements:

• Knowledge of and experience  reviewing Explanation of benefits (EOB) and Remittance Advise (RA)
• Strong knowledge of insurance types, associated administrative guidelines  and terminology
• Strong knowledge of payer portal navigation
• Understanding of insurance payment methodologies
• Basic understanding of appeals/denial resolution processing needs
• Microsoft Office
• Internet (Safari, Internet Explorer, Google Chrome)
• Strong communication skills
• Attention to detail when noting systems and accounts  
• Self-starter who can act when the need arises and use time efficiently when on hold with payors
• Utilize available resources (procedures, notes, training, system, etc.)
• Ability to work independently but also collaborate with a team as needed
• Strong customer service
• Ability to manage and organize tasks for maximum efficiency
• Skill to navigate multiple systems within dual monitors
• Comfortable with being on the phone for several hours of the day
• Detail oriented and analytical thinker
• Fast learner who can pick up new concepts and detailed procedures    
• Ability to thrive in a high demand environment    
• Knowledge of State policies/procedures on determining eligibility and claims processing
• Some knowledge of and experience with billing process and procedures
• Some knowledge of and experience with Hospital Patient Billing systems; language, flow of work, processes, and procedures
• High School Diploma or GED equivalent 
• Familiarity with UB04 and/or 1500 claims
• 1-2 years of collection or follow up experience is strong recommended.  
• 6 months to one year of administrative or customer service experience.