Position Summary:
PhyNet Dermatology is seeking skilled and motivated Billing Specialists to join our team. If you excel at insurance follow-up, denials management, and claims resolution, we encourage you to apply today. As a Denials Specialist, you will play a critical role in ensuring timely claims resolution and maintaining compliance with payer guidelines.
Location:
Atlanta, GA
Hybrid Work Schedule
Work on-site Monday through Wednesday and remotely Thursday and Friday.
Essential Functions:
To perform effectively in this role, the candidate must fulfill the following duties with or without reasonable accommodations.
- Monitor commercial, government, and specialty payer claims to ensure timely follow-up and resolution.
- Maintain a comprehensive understanding of payer guidelines, policies, and requirements related to denials and appeals.
- Update demographic and account information as needed to ensure clean claim submissions.
- Meet or exceed productivity and accuracy benchmarks set by management.
- Review medical records, provider notes, and Explanation of Benefits (EOBs) to facilitate appeals or resolve accounts.
- Initiate and manage appeals to insurance companies to resolve claims effectively.
- Handle payer correspondence, ensuring all required information is submitted promptly for claim processing.
- Analyze claim coding (CPT, ICD-9/10, HCPCS) to ensure accurate billing practices.
- Conduct detailed account follow-ups, analyze problem accounts, and document resolution efforts.
- Audit accounts for payment accuracy, contractual adjustments, and patient balances.
- Identify and report payer trends or recurring issues to management for resolution.
- Collaborate with patients, physician offices, and insurance companies to obtain additional information for claim processing.
- Generate patient responsibility statements and utilize insurance websites to address and resolve claims.
- Ensure proper documentation of all follow-up actions in the accounts receivable system.
- Maintain regular attendance and demonstrate a strong commitment to teamwork and professionalism.
Knowledge, Skills & Responsibilities:
- Prior experience in denials management and insurance claims follow-up.
- Hands-on knowledge of HCFA billing and EOB review.
- Familiarity with payer requirements, denial workflows, and appeals processes.
- Proficiency in electronic filing systems and general computer skills.
- Strong attention to detail with the ability to identify and resolve issues accurately.
- Excellent verbal and written communication skills, with a professional and courteous demeanor.
- Demonstrated ability to meet productivity expectations while maintaining high-quality work.
- In-depth understanding of CPT/ICD-9/10 and HCPCS coding.
This role requires a proactive, dependable, and detail-oriented individual with the ability to manage multiple tasks in a dynamic healthcare environment. The ideal candidate demonstrates a strong commitment to patient care and operational excellence.
Physical and Mental Demands:
The physical and mental demands described below are representative of those required to perform this job successfully. Reasonable accommodations may be made for individuals with disabilities:
- Physical Requirements:
- Occasionally required to stand, walk, and sit for extended periods.
- Use hands to handle objects, tools, or controls; reach with hands and arms.
- Occasionally required to climb stairs, balance, stoop, kneel, bend, crouch, or crawl.
- Occasionally lift, push, pull, or move up to 20 pounds.
- Vision Requirements:
- Close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
Note:
This job description is intended to provide a general overview of the role. Additional responsibilities may be assigned, or duties modified by the department supervisor based on operational needs.