Insurance and Denials Specialist — Oral Surgery

MAX Surgical Specialty Management • Philadelphia, PA

1d • $27 - $33

About The Position

Join MAX Surgical Specialty Management , an innovative leader in the healthcare industry, as we embark on an exhilarating journey of growth and expansion! We are seeking a motivated and dynamic individual to join our Revenue Cycle Management Team as a Insurance and Denials Specialist — Oral Surgery . What You'll Do: The Insurance and Denials Specialist — Oral Surgery will be responsible for all collection functions for oral surgery services. The primary responsibility of this position is account resolution which includes the following duties: reviewing accounts, following up with insurance companies on claim status, working claim denials, gathering and submitting any missing information, rebilling, appeals, and billing out secondary electronic or paper claims to all payers as needed. The successful candidate will be able to: -Resolve billing discrepancies and claim denials through follow-up with insurance companies. -Maintain clear communication with management about AR issues. -Review and interpret dental EOBs (Explanation of Benefits), including patient deductibles, co-pays, and insurance/third- party correspondence. -Research and navigate insurance policies, benefits, and exclusions to provide accurate information to patients & management team. -Manage insurance follow-up and denial management for assigned PODS. -Follow up to all third-party payers and self-pay accounts documenting appropriate information thoroughly on accounts. -Process re-bill accounts as appropriate. Alerts managers of any edits that may improve the billing process. -Post, research and resolve claim denials. -Ensures claim denial follow-up or appeals are completed and submitted within established payer filing limits. -Initiate insurance appeals or claim corrections to resolve denials -Investigates the payer claim denials. -Works all denials that pertain to, including but not limited to, duplicate claim, timely filing, EOB requests, not medically necessary denials, COB denials, etc. -Reviews and trends denial issues, identifies root cause and brings accounts to a final resolution. -Communicates denials and makes recommendations to improve current processes to eliminate future denial occurrence. -Address incoming correspondence related to claim denials and respond timely to ensure prompt resolution. -Contact insurance companies, patients, or account guarantors via phone and correspondence regarding claim denials. -Research payment discrepancies. -Reviews daily payment posting for underpayments and contractual allowance accuracy – pending adjustments -Works assigned monthly insurance follow-up report in a timely manner -Answer patient calls regarding open claims or patient balance. -Maintain productivity goals of 30-50 accounts per day -File all secondary insurance claims with appropriate EOB’s daily to avoid timely denials. -File all secondary insurance claims with appropriate EOB’s daily to avoid timely denials. -Gather payor trends and provide feedback to management. -Identifies and resolves specific coding issues and provides feedback to management. -Perform any and all other duties as assigned

Requirements

• High School Diploma, Medical Billing and or Coding Certification highly preferred, not required.
• Dental / Oral Surgery experience preferred
• Industry Expertise: 3+ years of hands-on experience in healthcare revenue cycle management, with a proven track record of optimizing processes
• Proficient in all Microsoft Office applications as well as medical office software
• Proven experience in healthcare billing
• Sound knowledge of health insurance providers
• Strong interpersonal and organizational skills
• Excellent customer service skills
• The ability to work in a fast-paced environment

Responsibilities

• Resolve billing discrepancies and claim denials through follow-up with insurance companies.
• Maintain clear communication with management about AR issues.
• Review and interpret dental EOBs (Explanation of Benefits), including patient deductibles, co-pays, and insurance/third- party correspondence.
• Research and navigate insurance policies, benefits, and exclusions to provide accurate information to patients & management team.
• Manage insurance follow-up and denial management for assigned PODS.
• Follow up to all third-party payers and self-pay accounts documenting appropriate information thoroughly on accounts.
• Process re-bill accounts as appropriate. Alerts managers of any edits that may improve the billing process.
• Post, research and resolve claim denials.
• Ensures claim denial follow-up or appeals are completed and submitted within established payer filing limits.
• Initiate insurance appeals or claim corrections to resolve denials
• Investigates the payer claim denials.
• Works all denials that pertain to, including but not limited to, duplicate claim, timely filing, EOB requests, not medically necessary denials, COB denials, etc.
• Reviews and trends denial issues, identifies root cause and brings accounts to a final resolution.
• Communicates denials and makes recommendations to improve current processes to eliminate future denial occurrence.
• Address incoming correspondence related to claim denials and respond timely to ensure prompt resolution.
• Contact insurance companies, patients, or account guarantors via phone and correspondence regarding claim denials.
• Research payment discrepancies.
• Reviews daily payment posting for underpayments and contractual allowance accuracy – pending adjustments
• Works assigned monthly insurance follow-up report in a timely manner
• Answer patient calls regarding open claims or patient balance.
• Maintain productivity goals of 30-50 accounts per day
• File all secondary insurance claims with appropriate EOB’s daily to avoid timely denials.
• File all secondary insurance claims with appropriate EOB’s daily to avoid timely denials.
• Gather payor trends and provide feedback to management.
• Identifies and resolves specific coding issues and provides feedback to management.
• Perform any and all other duties as assigned

Benefits

• Highly competitive salaries & annual performance and compensation reviews
• Competitive health insurance and benefits, including medical, dental, vision, disability, and more
• 401k retirement savings plan that includes employer match
• Generous Paid Time Off, sick leave, and paid holidays
• Advance your career growth with opportunities in the most extensive growing oral surgery practice in the Northeast

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED