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About the Role

This role supports the CommunityCare Revenue Cycle Management (RCM) team by following up on and resolving outstanding insurance claims, ensuring accurate claim status notes, and maintaining claim integrity.

Responsibilities

• Contact insurance carriers daily to collect past due amounts on outstanding medical claims.
• Maintain an accurate aging of assigned accounts, including AR analysis and follow-up.
• Stay updated on billing and medical policies for all payers.
• Understand In and Out of Network reimbursement processes.
• Create and follow up on appeals for denied or incorrectly paid claims.
• Review and resolve complex denials and tasks assigned by the payment posting team.
• Collaborate with RCM departments to resolve claims payment issues.
• Ensure compliance with company policies, procedures, mission, and values.
• Review and resolve open accounts with the AR Supervisor.
• Perform other duties as assigned.

Requirements

• High level of skill in building relationships and providing excellent customer service.
• Ability to utilize computers for data entry, research, and information retrieval.
• Strong attention to detail, accuracy, and multitasking abilities.
• Highly developed problem-solving skills.
• Professionalism when interacting with staff, payers, patients, and families.
• Ensure services are provided in accordance with state and federal regulations, organizational policy, and accreditation/compliance requirements.
• Act in accordance with CommUnityCare’s mission and values, serving as a role model for ethical behavior.
• Promptly identify and report issues to the direct supervisor.
• Maintain regular and predictable attendance.
• Manage high volumes of work and organize/maintain a schedule independently.
• Effectively monitor steps in claims processing operations.

Skills

• Data entry
• Research
• Information retrieval
• Problem-solving
• Customer service
• Excel
• Microsoft Office Suite
• Medical practice management software
• Electronic medical records

Location

• Remote

Work Type

• Full-time

Experience Level

• 3 years of experience managing Accounts Receivable and performing direct follow up with payers.
• 1 year experience communicating effectively, both orally and in writing, with insurance payers and internal company communications.
• 3 years working with medical terminology, ICD10, CPT, HCPCs coding and HIPAA requirements.
• 2 years of experience with data processing and analytical skills.
• 3 years of experience working with commercial, government and state insurance payers and their reimbursement policies and procedures.
• 3 years' experience working complex insurance issues, including assigning correct payer, EOB adjustments and refunds to accounts.

Education Level

• High School Diploma or GED

About the Company

• CommunityCare Revenue Cycle Management (RCM) team