Hospital Billing in West Hempstead, NY at Engage Partners, Inc.

Date Posted: 11/7/2020

Job Snapshot

Job Description

Job Description
The client is currenlty looking for a full time Hospital Billing & Appeals Specialist for both hospital inpatient and outpatient claims.
Job Summary:
Creates and manages submission, intervention and resolution of bills, appeals, and grievances. Conducts pertinent research, evaluates, responds and completes appeals and other insurance/policy guideline inquiries accurately, timely and in accordance with all established regulatory guidelines. Prepares appeal documentation, summaries, correspondence, as well as documents information for tracking/trending data. Review denied insurance claims, identify and resolve the issues in order to resubmit. Develop strategies to reverse claim denials. Manage and organize appeal workflow based on internal and insurance-driven deadlines. Researches insurance policy language to determine medical necessity criteria. Request and obtain medical records, notes, and/or detailed bills as appropriate to assist with research. Collaborates with other team members to determine appropriate responses. Prepare documentation for submitting bills/grievances/appeals. Creates and/or maintains statistics and reporting. Monitors and tracks the number of appealed claims. Assure timeliness and appropriateness of all appeals according to state, federal, and company guidelines, but not limited to.
Required experience:
Prior experience in the creation, submission, and completion of all hospital bills and insurance appeals.
Knowledge of Medicare and Medicaid rules and regulations.
Office administrative experience and the ability to work independently while effectively researching and maintaining the most current government laws and patterns of insurance denial, etc.
Computer literacy, especially with MS Office
Desired Skills:
Efficient multi-tasking.
Strong organizational skills
Ability to prioritize workload based on strict deadlines.
Attention to detail.
Effective organization of work assignments.
Effective written and oral communication.
Ability to self-motivate and learn quickly.
Ability to review and understand insurance policy language and guidelines.
Understand and comply with HIPAA regulations.
Familiarity with Commercial Insurance, Medicaid and Medicare claims denials and appeals processing, and knowledge of NCCI guidelines and LCD/NCD Edits for appeals and denials.
Ability to accept change in work assignments as needed.
Performs other duties as assigned.
Familiarity with Cost Outliers a plus.
Job Type: Full-time