Scottsdale, Arizona
Claims Specialist I Job Opening in Scottsdale, Arizona - SUMMARY: The primary purpose of this position is to adjudicate claims and liaison by communicating and resolving root cause analysis (RCA) between billing and follow-up to ensure maximum reimbursement to AMF. Acts as a focal point within the company for all revenue cycle activities.
RELATIONSHIPS :
Interfaces To: All employees, vendors and customers
Supervises: None
ESSENTIAL DUTIES & RESPONSIBILITIES:
Works with insurance companies, billers, Flight Coordination and leadership to ensure reimbursement is maximized for AMF.
Analyzes workflow and operational procedures to identify opportunities for improved reimbursement, develops and implements policies and procedures with leadership to ensure all services are captured, recorded, processed and billed in an accurate and timely manner.
Ensures payment is received, credited and recorded at contracted rates. Identifies and researches discrepancies through data analytics and root cause analysis to improve upstream processes.
Analyzes billing and accounts receivable reports. Identifies payor trends, categories of aged receivables and provides feedback to stakeholders to improve results. Works with payors and Flight Coordination personnel to identify trends and implement strategies that ultimately save cost and improve revenue lift.
Works with Legal team to ensure proper payment is received and highlights trends of payor underpayments.
Maintains a working knowledge of Eligibility and Benefits, Insurance, authorization, and SPD Salesforce sections.
Reviews, modifies and recommends changes to policies and procedures to improve Accounts Receivables Days.
Meets regularly with Revenue Cycle leadership to address reimbursement and data needs and recommends target areas for reimbursement improvement.
Prepares and distributes monthly cycle reports for departments. Downloads appropriate data from system and compiles information in a user-friendly understandable manner. Reports include target vs. actual collection rates and actual vs. target Accounts Receivable (A/R) days.
Monitors insurance cash collections policies and procedures and educates Flight Coordination staff to ensure best practice sharing across company.
WORKFLOW/PROCESS IMPROVEMENT:
Ensures Revenue cycle goals and productivity standards are met for optimum utilization
Helps identify methods to improve service delivery
QUALIFICATIONS:
REQUIRED:
Education: High school diploma or GED
Experience: A minimum of three years in a healthcare environment or work related experiences and/or educational accomplishments with knowledge of the following functions: CPT coding, HCFA 1500 billing requirements, quantitative reporting methods and systems, project management, data analytics, and Salesforce. A combination of both will be considered.
The ability to work independently, handle multiple tasks and exhibit problem-solving skills are essential.
PREFERRED:
Education: Bachelor?s degree
Experience: Process Improvement skills (Lean, Six Sigma, Process Excellence); Healthcare and revenue cycle experience (medical billing, collections); Experience reviewing 1500 claims; experience. Knowledge of collections, reimbursement and Salesforce is highly preferred.
PHYSICAL DEMANDS: Physical demands described here are representative of those that must be met by an employee to successfully perform essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing duties of this job, the employee is continually required to sit. The employee is frequently required to talk and/or hear. The employee is occasionally required to stand, walk, use hands to finger, handle or feel, and reach with hands and arms. Job duties require employee to function effectively and independently while maintaining good working relationships with partners, employees, and customers.
The employee may occasionally lift and/or move up to 25 pounds. There are no specific vision abilities required by this job.
WORK ENVIRONMENT: Work environment characteristics described here are representative of those an employee encounters while performing essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
While performing duties of this job, the employee is continually required to be indoors. The employee will experience quiet to moderate noise in the office (examples: business office with various office equipment and/or light traffic).
FLSA STATUS: Non-Exempt
Job Type: Full-time
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
Claims: 3 years
Healthcare: 2 years
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