Full-Time Medical Claims Billing Specialist

• Management of the accounts receivable (AR) including analysis of the aged AR, looking for root cause issues; suggesting billed rules/edits when appropriate to stop errors from occurring
• Denial management - investigate denial sources, resolve and appeal denials which may include contacting payer representatives
• Make independent decisions regarding claim adjustments, resubmission, appeals, and other claim resolution techniques
• Collaborate with internal teams (Performance, Operations, Sales) as well as, care center staff when appropriate
• Support large care center go lives when applicable, which may include overnight travel
• Work closely with our Revenue Optimization team to support efforts to ensure reimbursement is in line with payer contract agreements. Perform denial analysis utilizing the Trizetto platform.
• Work directly with practice consultants or physicians to ensure optimal revenue cycle functionality
• Drive toward achievement of department’s daily and monthly Key Performance Indicators (KPIs)
• Other duties as assigned

• High School Graduate
• 3+ years experience in a medical billing office or equivalent claims experience
• Prior experience working with Arizona-based payors is highly desirable.
• Must understand the drivers of revenue cycle optimal performance and be able to investigate and resolve complex claims
• Advanced Microsoft Excel skills (ex: pivot tables, VLOOKUP, sort/filtering, formulas) preferred
• Experience with athenaHeath and/or athenaOne preferred
• Must comply with HIPAA rules and regulations

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