Job Description

Denials and Appeals Representative will resolve issues associated with claim denials by working in a customer-oriented manner with both internal and external parties. Our ideal candidate is motivated, a confident decision-maker, detail oriented, has a proven track record in accuracy, and utilizes effective communication skills. Consistently meet or exceed productivity standards, targets, error ratios, and reporting requirements as assigned by the Back End Revenue Cycle Supervisor.

Compass Health Center is a recognized leader in crisis-level mental health, setting the standard for excellence in the PHP/IOP space. Our evidence-based approach (CBT, DBT, ACT) and collaborative, team-based environment make Compass the best place to start or build your career.

Our rapid growth continues to create new opportunities as we continue to push for better and differentiated care for our patients seeking treatment for anxiety, depression, trauma, substance use, and other co-occurring conditions.

Responsibilities Include:

• Assessment of claim denials to determine and execute the appropriate course of action for resolution.
• Investigate denied claims to ensure timely follow-up and collection of third party payer receivables.
• Root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution.
• Perform daily, systematic reviews of work lists to ensure all accounts already to be worked are completed.
• Utilize Government, Commercial, and regulatory guidelines for collection of outstanding accounts.
• Recommend accounts for contractual or administrative write-off and provide appropriate justification and documentation.
• Demonstrate excellent customer service through oral and written communication in providing assistance/expertise to patients, authorized guarantors, and other external and internal contacts.
• Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
• Provide individual contribution to the overall team effort of achieving the department accounts receivable goals.
• Identify opportunities for system and process improvement and submit to management.
• Demonstrate proficient use of systems and execution of processes in all areas of responsibilities.
• Assist the Revenue Cycle Supervisor with special projects and other duties as assigned, as necessary.

Required:

• High School Diploma.
• 2 years related work experience or college degree.
• Working knowledge of physician and facility billing and follow-up including understanding of insurance rules and regulations
• Knowledge of HIPAA standards.
• Excellent communication skills to include oral and written comprehension and expression.
• Basic knowledge of medical terminology and billing practices.
• Extensive experience and knowledge of PC applications, including Microsoft Office and Excel.
• Ability to work independently and to carry out assignments to completion
• Ability to learn and adapt quickly and meet continuous timelines.

Desired:

• 2 + years college or college degree.
• Two (2) years progressive work experience in a hospital/ physician billing or SBO environment.
• Detail-oriented, good organizational skills, and ability to be self-directed.
• Strong time management skills, managing multiple priorities and a heavy workload in a high-stress atmosphere.
• Flexibility to perform other tasks as needed in an active work environment with changing work needs.
• High-level problem solving, analytical, and investigational skills.
• Excellent internal/external customer service skills.