Technical Specialist

Review, research and address non-clinical denials Address accounts assigned to work queues and complete required activities Perform follow-up, appeals and referrals to stakeholders Investigate and respond to information requests to resolve outstanding accounts Monitor denial accounts and document actions to maximize collection dollars Use appropriate systems to research accounts and submit processing or appeal information Follow up with patients to obtain additional information Prepare and submit payer appeals, including escalation through payer joint operating calls Make outgoing calls and answer incoming calls Revise insurance information and request rebilling or account adjustments as appropriate Review, work and accurately report aged accounts Track and report payer prompt-pay/adjudication violations and follow up with payers Interface with internal and external staff to resolve payment variance issues Report issues and trends to management and collaborate on solutions Facilitate joint operating calls, manage payer spreadsheets, coordinate meetings and submit agendas Participate in educational activities and maintain compliance with policies, regulations and privacy requirements Meet expectations for data quality, customer service, payment variance turnaround and productivity Perform other duties as assigned Requirements Associate degree OR high school diploma plus Certified Revenue Cycle Representative and 3 years of related experience 3 years’ experience including customer service etiquette and interaction with internal and external stakeholders Proficiency in Microsoft Office applications and others as required Knowledge and understanding of organizational policies and procedures Knowledge of insurance regulations, payment guidelines and policies Ability to communicate and work with payors to get accounts resolved and paid accurately Extensive knowledge of Medicare and Medicaid regulations Knowledge of third-party claim filing, contract reimbursement and other insurance guidelines Compliance with federal, state and local regulations and HIPPA Satisfactory attendance and punctuality Ability to prioritize work/resources to accomplish objectives and meet deadlines Core Competencies Demonstrates expertise in managing non-clinical denials, appeals, and payment variance issues while ensuring compliance with insurance regulations and organizational policies. Proficient in utilizing Microsoft Office applications and maintaining high standards of customer service and data quality. Highest-signal resume keywords Certified Revenue Cycle Representative Medicare and Medicaid Regulations Insurance Regulations Customer Service Etiquette Third-Party Claim Filing Hard Skills Non-Clinical Denial Management Appeals Processing Payment Variance Resolution Data Quality Management Account Adjustments Payer Joint Operating Calls Insurance Information Revision Aged Account Reporting Compliance with HIPAA Organizational Policies and Procedures Soft Skills Communication with Stakeholders Collaboration with Internal Staff Prioritization of Work Customer Service Problem-Solving Certifications & Qualifications Certified Revenue Cycle Representative Industry Keywords Payment Guidelines Contract Reimbursement Federal Regulations State Regulations Local Regulations Tools & Technologies Microsoft Office Applications Payer Spreadsheets Research Systems #J-18808-Ljbffr Jobtailor