Data
This position is responsible to resolve aged accounts and must have denial management experience in multiple states and sometimes internationally. Must have Revenue Cycle Management experience. Professional communication skills are required for interaction with colleagues, payors and management. Experience working in the ambulance transportation field preferred.
Denial Management – Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
Trend Identification – Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
Payor Escalation – Ability to understand and navigate payor guidelines. Determine and escalate claim issues with payor when appropriate.
Trend Escalation – Meet with leadership to discuss/resolve reimbursement and/or payor obstacles.
Appeals – Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier. Take appropriate action to resolve claim.
Claim Status – Use available resources such as payor portals and clearinghouses to review unresolved accounts.
Unapplied Payments – Identify unapplied payments and take appropriate action to resolve account.
Phone Calls - Call appropriate payors or patient to obtain the information necessary to resolve the claim.
Medical Record Requests – Obtain necessary information from appropriate source(s) to obtain payment from payors. This includes obtaining records from treating facilities.
Medical Insurance Policies - Knowledge and understanding of current policies and procedures required to determine claim resolution.
Overpayment Resolution – Process or appeal refund requests following federal, state and/or payor guidelines.
Legal/Subrogation Requests – Knowledge of HIPAA and multiple state guidelines to process attorney requests.
Coordination of Benefits – Ability to review eligibility response and determine payor sequence. Knowledge of Medicare Part A vs Part B benefits and liability guidelines.
Patient Inquiries - Respond to written and verbal inquiries from patients regarding their account. Process charity and payment plan following established policy.
Communication – Clear and concise communication both written and verbal, including documenting all activities associated with an account.
Production and Quality Standards – Must meet company standards and ability to work in fast paced environment.
Other responsibilities as assigned
Qualifications
Prefer minimum 3 years in medical reimbursement field
Ability to read and understand EOBs
MS Excel skills (filtering and formatting reports)
MS Word skills (formatting of letters and templates)
PDF (formatting and editing in Adobe Acrobat or equivalent)
Position requires HS or GED equivalent and some college level courses
Ability to speak confidently to insurance representatives and patients
Experience in billing 1500 and UB04 claim forms
Understanding of non-contracted and contracted payer behaviors
Ability to interact professionally on all levels
Type 45 wpm, 10-key by touch
Knowledge of medical terms.
Ability to operate office equipment.
Candidate must be able to provide documentation to support ability to work in the United States within the federal legal guidelines.At ZOLL, we're passionate about improving patient outcomes and helping save lives.
We provide innovative technologies that make a meaningful difference in people's lives. Our medical devices, software and related services are used worldwide to diagnose and treat patients suffering from serious cardiopulmonary and respiratory conditions.
ZOLL Data Systems, a division of ZOLL Medical Corporation, is a healthcare software solutions provider that empowers hospital, EMS and Fire, and billing/accounts receivable (AR) teams to deliver more—from better patient outcomes to operational efficiencies and greater revenue capture. Our business exists to help save more lives through data-driven innovation and interoperability, opening new pathways for our customers to achieve the highest levels of care, collaboration, and reimbursement.
Essential FunctionsRequired/Preferred Education and ExperienceZOLL is a fast-growing company that operates in more than 140 countries around the world. Our employees are inspired by a commitment to make a difference in patients' lives, and our culture values innovation, self-motivation and an entrepreneurial spirit. Join us in our efforts to improve outcomes for underserved patients suffering from critical cardiopulmonary conditions and help save more lives.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
