Insurance Auditor Tier 2 - Denied Claims

Title: Insurance Audit Tier 2

Work Schedule: Monday through Friday, 8:00am – 5:00pm. 1 hour for lunch. Some overtime may be required when pre-approved.

Classification: Full-time hourly position with non-exempt status

Job Summary: Work all assigned functions of the billing process for assigned specialty. Monitor and collect A/R for assigned clinics. Provide exceptional service to team and clients assigned, medical billing auditing, and teamwork to those around you, also responsible for communicating with clients, any Tier 1 Auditors under you, and Insurance Audit Manager. Managing the denial process and working the denied claims to the full extent for the client. The goal of this position is to bring full closure to each and every claim as outlined by the departmental and company guidelines.

Supervision Received: Reports to Insurance Audit Manager/Director of Operations

Location: Moore, Oklahoma (in office only)

Compensation: $18.00 and up per hour worked depending upon knowledge and background

Essential Functions Expectations:

• Daily check-ins to regularly communicate with Tier 1 Audit staff and Department Managers.
• Aging Reports-
• Contact payers for claims status or to follow up on denials or partial payments
• Work AR aging reports 60 day and up category
• Work with Tier 1 Auditor to resolve more complicated issues
• Correspondence as assigned – work escalated unresolved issues flagged from Tier 1 Auditors
• Escalate unresolved issues immediately to management/Department Manager
• Cover any records requests escalated from Tier 1 Auditor
• Check provider portals routinely requests needing attention or assigned
• Initiate the review/appeal process on disputed claims
• Work closely with Charge Entry department for successful attainment of company goals as needed.
• Work closely with Receipts department and provide feedback as needed to include Tier 1 Auditor assigned duties
• Prioritize escalated emails/claim issues from Patient Responsibility Team
• Document all activity in the patients’ account for reference on each claim touched – must be completed on each claim
• Complete File Maintenance daily
• Keep Client files organized in the share drive according to training for all departments to follow and understand
• Answer A/R phone/email inquiries; to include involving Client communications as needed to strengthen the Audit-Client relationship
• Work financial reports to target all claims
• Participate in any or all mandatory meetings
• Be sure to mentor your Tier 1 Auditor for guidance and ongoing training
• Adhere to all company policies and procedures
• Adhere to strict confidentiality of clients and patients; HIPAA rules and Regulations
• Stay available for all inquiries and help team members as needed
• Bringing full closure to each claim and work the denials to the fullest of contractual obligations per client.
• Attendance; reporting to work regularly and on time is an essential function of this position.
• Patient phone calls as assigned
• All other duties as assigned and agreed to in the future as changes occur.

Education: High School Diploma or equivalent and multiple years (2-3 full years) of Medical Insurance Audit experience is a requirement for this position. Please understand this will be verified for your eligibility for this position. Those with no required experience need not apply.

Physical Requirements: Sitting for up to 2 hours at a time, able to lift up to 20 pounds. This position requires repetitive hand motion.

Skills/Experience

• Must be dependable and punctual on a daily basis – reliability is key
• Attendance; reporting to work regularly and on time is an essential function of this position.
• Must have good time management skills
• Maintain a professional, polished image
• Must be organized and handle stressful situations in a calm manner
• Must be able to multitask
• Must have critical thinking skills regarding medical claims and the denial process
• Ability to follow direction and contribute in a positive, proactive way to the overall goals
• Team player, adaptable, and flexible with tasks assigned
• Ability to communicate effectively, both verbal and written
• Knowledge of relevant medical billing software applications (Medisoft, ECW, Advanced MD, EPIC – Community Connect)
• Knowledge of computer software. Including Microsoft Word, Outlook, Excel, Teams, and other programs.
• Medical billing experience (physician side of billing) and terminology is required with extensive knowledge of insurance denials

For questions or issues with submitting resume please contact Jennifer at 405-310-0836 ext. 555

Job Type: Full-time

Pay: From $18.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Microsoft Office: 2 years (Required)
• Customer service: 1 year (Required)
• denied medical claims: 3 years (Required)

Ability to Commute:

• Moore, OK 73160 (Required)

Ability to Relocate:

• Moore, OK 73160: Relocate before starting work (Required)

Work Location: In person

Salary : $18