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About the Role

Ensure full reimbursement for clinical services by accurately managing receivables, resolving claim edits, and researching/resolving denials to secure payment. This role involves working collaboratively to improve complex business processes.

Responsibilities

• Review and accurately process claim edits in a system work queue.
• Accurately handle claim adjustments and coverage changes.
• Review and process claim denials according to established processes.
• Research and resolve denial issues via payer website, coverage policies, and phone calls.
• Submit corrected claims and appeals.
• Process account adjustments and refunds according to department policy.
• Document actions appropriately and follow-up with payers.
• Follow-up on claims with no responses.
• Manage large workload using tracking tools to ensure timely follow-up.
• Participate in team meetings to review new procedures, denial types, and system updates.
• Report problems and patterns to the supervisor to help keep policies and procedures up to date.
• Acquire and maintain knowledge of system terminology, claim/denial/coverage concepts, and HIPAA rules.
• Expertly use insurance websites and internal tools to resolve denial issues.
• Respond to patient complaints by researching coverage and claim processing.
• Contact insurance as needed.
• Coordinate resolution with Customer Service staff.

Requirements

• At least one year experience in a Medical Office environment preferred.
• Basic knowledge of medical billing, coding, collection processes, insurance policies and governmental regulation provision preferred.
• Knowledge of UBO4 billing form and 1500F05 specific payer requirements preferred.
• Excellent problem solving, organizational and oral and written communication skills required.
• Successful completion of annual age and job specific competencies and skill verification tools required.
• Proficiency in a variety of computer applications and spreadsheet applications and common office equipment.

Skills

• Ms office suite
• epic
• problem management
• Ability to positively work within a team environment

Location

• Irondequoit, NY

Work Type

• Contract to Hire
• fully onsite

Experience Level

• Intermediate Level

Salary/Compensations

• $18.50 - $19.00/hr

Benefits

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

About the Company

• We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
• We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.

Equal Opportunity

• The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
• The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
• San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
• Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
• Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.