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Job Requirements of Allowables Representative:
QUALIFICATIONS / EXPERIENCE:- Thorough knowledge of physician billing policies and procedures
- Thorough knowledge of healthcare reimbursement guidelines
- Computer literate, intermediate knowledge of Excel/Word preferred
- Ability to work independently in a fast-paced environment
- Excellent oral and written communication skills
- Good analytical and organizational skills
- Minimum high school diploma, or equivalent
- 1 – 3 years of experience in physician medical billing with emphasis on research, contract review and claim denials
- General knowledge of ICD and CPT coding guidelines
PHYSICAL / ENVIRONMENTAL DEMANDS:
- This position involves high production volume in a pleasant, fast-paced environment with extensive computer use
- Job is performed in a well-lighted, climate-controlled, modern office setting
- Prolonged sitting at a workstation using a computer
- Moderate phone use, bending and standing
- Moderate stress level
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, and fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions.
Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
Do you meet the requirements for this job?
Allowables Representative
TeamHealth
Akron, OH (Remote)
Full-Time
TeamHealth is named among the Top 150 Places to Work in Healthcare by Becker's Hospital Review. Newsweek Magazine recognizes TeamHealth as ‘one of the greatest workplaces for diversity, 2024’ and TeamHealth is also ranked as ‘The World’s Most Admired Companies’ by Fortune Magazine. TeamHealth, an established healthcare organization is physician-led and patient focused. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us!
What we Offer:
JOB DESCRIPTION OVERVIEW:
The Allowables Analyst will review, organize, and resolve invoices that have allowable variance denials, taking appropriate corrective action as directed by the Allowables Manager. The Analyst researches carrier denials as needed and processes payment disputes/appeals for assigned states and/or payers.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
What we Offer:
- Career Growth Opportunities
- Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
- 401K (Discretionary matching funds available)
- Generous PTO
- 8 Paid Holidays
- Equipment Provided for Remote Roles
JOB DESCRIPTION OVERVIEW:
The Allowables Analyst will review, organize, and resolve invoices that have allowable variance denials, taking appropriate corrective action as directed by the Allowables Manager. The Analyst researches carrier denials as needed and processes payment disputes/appeals for assigned states and/or payers.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Monitor and review invoices with allowable variance denials within assigned states/payers. Analyst performs research as needed, to include eligibility verification for FSC appropriateness, EOB review, posting accuracy review and processing subsequent payment disputes/appeals with the carrier via an appropriate method for the invoices involved
- Generate and/or utilize variance reports (Daily, Weekly, Monthly, On-Demand) to identify carriers with allowable variance denials, reporting any noted trends to the Allowables Manager. Review the Underallowed Monthly Aging report and adjust priorities as necessary
- Utilize the telephone and available carrier portals/websites for research, submission of payment disputes/appeals and otherwise expediting issue resolution
- Review carrier Provider Manuals, portals and websites and inform management of any new carrier procedures/requirements as applicable
- Monitor the progress of payment disputes/appeals
- Routinely review monthly Managed Care/Contract Management meeting minutes, noting trends and as a directive for assembly of monthly MC/CM meeting reports
- Consult with Allowables Manager for unusual circumstances that may include system data issues, payer responses and MC/CM/PCM maintenance issues
- Process carrier phone calls/correspondence regarding Contracted Payor Notification letters
- Consistently meet established completion times for projects and assignments
- Consistently meet/maintain QA (95% or better) and designated production standards
- Perform additional duties as directed by the Allowables Manager
Job Requirements:
QUALIFICATIONS / EXPERIENCE:
PHYSICAL / ENVIRONMENTAL DEMANDS:
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, and fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions.
Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
- Thorough knowledge of physician billing policies and procedures
- Thorough knowledge of healthcare reimbursement guidelines
- Computer literate, intermediate knowledge of Excel/Word preferred
- Ability to work independently in a fast-paced environment
- Excellent oral and written communication skills
- Good analytical and organizational skills
- Minimum high school diploma, or equivalent
- 1 – 3 years of experience in physician medical billing with emphasis on research, contract review and claim denials
- General knowledge of ICD and CPT coding guidelines
PHYSICAL / ENVIRONMENTAL DEMANDS:
- This position involves high production volume in a pleasant, fast-paced environment with extensive computer use
- Job is performed in a well-lighted, climate-controlled, modern office setting
- Prolonged sitting at a workstation using a computer
- Moderate phone use, bending and standing
- Moderate stress level
This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, and fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions.
Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.
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