RCM Specialty Follow Up Specialist - Worker's Comp

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Summary
Title: RCM Specialty Follow Up Specialist – Workers Comp
Department: Central Business Office
Location: Security Park – B27

The RCM Specialty Follow Up Specialist for Workers Comp ensures accurate and timely submission of insurance claims, obtaining missing information, researching denials and documentation, following up on claims, and maintaining compliance with department standards, HIPAA, and governing agency policies and procedures. This position is also responsible for taking action required to resolve rejected, underpaid and denied claims by submitting corrected claims and appeals on a timely basis upon review of unpaid encounters. Works closely with the CBO, practice managers, billers, and coders.

Availability Requirements:

• Ability to work 40 hours per week
• Day Shifts between the hours of 7:30 – 5:30
• 8-hour shifts Monday-Friday
• 9-hour shifts Monday – Thursday | 4-hour shift Friday

Our Mission: To improve the quality of life for our community by providing the best patient experience for every patient.

Our Vision: To be the best place to work and the best place to receive healthcare.

Benefits: UMC Physicians offers a comprehensive benefits package to eligible full-time employees. Benefits include:

• Paid Time Off
• Sick Pay
• Medical, Dental and Vision Insurance
• Employer Paid Group Life and Voluntary Life Insurance
• Short Term Disability Insurance
• Long Term Disability (after 2 years of employment)
• Critical Illness, Accident and Cancer Insurance
• Health Care and Dependent Care Spending Accounts
• 401K Retirement Plan with Company Match
• Employee Assistance Program

Note: Some benefits require an employee contribution to participate.

Essential Functions:

• Review, research and resolve coding denials for complex diagnostic studies,

endoscopic, interventional and/or major surgical procedures. (This includes
denials related to the billed CPT, diagnosis, and modifier.)

• Denial types could include bundling, concurrent care, frequency, limited

coverage and authorization.

• Prepare and submit claims appeals, based on payor guidelines.
• Identify denial, payment, and coding trends in an effort to decrease denials,

improve denial prevention, and maximize collections.

• Contact payers via website, phone and/or correspondence, regarding

reimbursement of claims denied.

• Interpret medical policies and/or Medicare, Medicaid Federal/Government

rules and regulations to ensure proper reimbursement/collection.

Additional Responsibilities:
Additional duties as assigned.

Knowledge/Skills/Abilities:

• Requires knowledge of carrier specific claims appeal guidelines. (This

includes claim logic, internet, and paper/fax processes.)

• Requires knowledge of CPT and ICD-10 coverage policies, internal revenue

cycle
coding processes and the billing practices of the specialty service line.

• This position requires clear and concise written and oral communication

with payors, providers, and billing staff to ensure resolution of denials.

• Requires the ability to read and interpret E&M notes, complex diagnostic

study results, endoscopic and interventional results and/or major surgical
operative notes.

• Determine appropriate action for denial resolution based on documentation.

Minimum Qualifications:

• High School diploma or equivalent
• Two (2) years medical billing or collections required (combination of higher

education and experience may be considered to satisfy years of experience
requirement.)

• Medical terminology
• Type 40wpm, 10 key by touch.
• Strong analytical and critical thinking.

Preferred qualifications:

• Knowledge of Medicare, Medicaid, Commercial, Federal/Government

Insurance procedures.

• Knowledge of denial management, billing/coding guidelines
• Experience in Cardiothoracic, Gastrointestinal, Neurology, OB,

Anesthesiology,
and/or Allergy Specialties.

• Previous Workers’ Compensation is preferred.

Environmental Conditions:
Works in well-lit, heated and ventilated building. Exposure to blood borne pathogens are of low risk. Hours of duty may be irregular.

Physical Requirements:
• Requires prolonged sitting, some bending, lifting, stooping, and stretching. •

• Requires eye-hand coordination and manual dexterity sufficient to operate a

keyboard, copier, telephone, adding machine, fax machine, printers and other
minor office equipment.

• Requires normal range of hearing and eyesight to record, prepare and

communicate appropriate reports.

• Must be able to communicate in person, via voicemail, via email and on the

telephone.

Limitations and disclaimer: The above job description is meant to describe the general nature of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position. This position is security sensitive.
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