At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

• The Account Resolution Specialist will be responsible for supporting A/R resolution in our Central Business Office by effectively and efficiently researching claims and taking action with the insurance payers to achieve timely account adjudication
• The ideal candidate has the ability to recognize and solve issues as appropriate, interpret contract terms to ensure accounts receivables are properly stated, in addition to writing and processing underpayment technical appeals

Essential Function

• Review unpaid claims, research reasons for delay, and work with payers to resolve the issues
• Initiate collection follow-up of unpaid or denied claims
• Effectively follows up on appeals and resolves claim rejections, underpayments, and denials
• Research technical payer denials related to referral, pre-authorization, non-covered services, and billing resulting in denials and delays in payment; Initiate appeals with insurers appropriately
• Develop and submit detailed, customized appeals to payers based on review of denial, applicable records, and in accordance with payer guidelines as well as Kindred’s policies and procedures
• Review outstanding accounts and aging reports
• Processes adjustments when required
• Responsible for stat using of A/R
• Replies to insurance companies requests for additional documentation in a timely manner
• Communicates pertinent information to Business Office Director
• Track trending issues
• Work with multiple systems daily
• Review EOB’s to identify payment errors, denials and low reimbursement
• Make phone calls regularly to insurance companies for claim follow up
• Research account receivables for both Medicare and Non-Medicare collections
• Conduct thorough account research and analysis
• Recognize, reconcile and resolve account discrepancies
• Provide timely notation of action taken on patient accounts; process refunds to insurance carrier or patient; correct late charges; monitor insurance coding and effective/exhaust dates
• Responsible for identifying net revenue hits and pick-ups
• Responsible for underpayment variance reviews
• Responsible for identifying, logging, and effectively working denials
• Ability to read an insurance contract and monitor claims accordingly

Knowledge/Skills/Abilities

• Demonstrate ability to research, analyze and resolve problems
• Ability to multi-task
• Good communication skills (both verbal and written)
• Ability to use independent judgment to recognize and solve issues
• Demonstrates the ability to work independently and takes initiative
• Desire to make a positive impact with the ability to manage multiple tasks and shift priorities
• Team player with a strong sense of ownership and accountability
• Detail oriented, organized, and motivated

Education

• High School Diploma

Experience

• 2+ years of experience in healthcare collections