10 days old

Claims Review Specialist

Kelly Services
Asheville, NC 28815
Kelly Services is hiring Claims Review Specialists in Tallahassee!

This is a temp to perm position for a candidate that has at least 2 years in medical claims & benefits, experience with medical billing is a plus!

+ Working Hours: 8:00am - 4:30pm Monday - Friday Occasional extended hours may be required to meet business needs.

+ Training Hours: 8:00am - 4:30pm Monday - Friday Occasional extended hours may be required to meet business needs.

**Position Summary:** The Denial Specialist is responsible for working third party A/R and denials to ensure appropriate payment for Genova s claims and timely resolution of third party accounts receivable according to Genova policy. Completes denial follow up and no response research with insurance carriers, patients, and clients to ensure claims are processed and to obtain adjudication information. He/she re-submits claims and appeals as necessary to ensure appropriate and timely reimbursement. The Denial Specialist is responsible for maintaining the 48 hour turn-around time requirement for the daily posting of all payment/adjustment categories including check, EFT, and Zero payment, Patients, Consumers, EOB s and remittances manually and electronically. Interpretation of the Explanation of Benefits EOB and claim adjudication will be required in order to post remittances at the CPT code and denial code level. The position is responsible for the accurate posting of payments and adjustments to the correct invoices. This position supports billing processes and other A/R processes as necessary to ensure excellent cash collections and DSO performance.

**Essential Duties and Responsibilities:** Responsibilities include but are not limited to the following: Technical Maintains full awareness of compliance issues in relation to any insurance contracts, and other insurance regulatory issues. Must report any concerns with applicable government regulation, compliance issues to the Office of Quality. Works patient accounts to ensure appropriate adjudication and payment of claims. Processes re-bills, appeals, and processes adjudication information. Makes corrections to patient accounts in billing system to obtain reimbursement for claims. Works in clearinghouse system to correct claims and obtain information required to obtain reimbursement for claims. Uses web resources, imaging system, A/R system, clearing house, and other Genova systems in the course of working A/R and denials to obtain information required for appropriate reimbursement. Work denials from third party payers. This includes submitting requested lab results, corresponding with practitioners to obtain medical records and resubmitting claims as needed. Prepare and submit any insurance secondary billing when appropriate. Interpretation and posting of all 3rd party insurance including Medicare and Medicaid EOB s and remittances, manually and electronically to both SCC and to the reimbursement database DAD . Including the reconciling of daily Cash batches back to the deposit totals. Processes patient accounts to ensure appropriate adjudication, payment, and posting of adjustments/payments. Forwarding EOB and Insurance remittances to Denial Management Team for review and further action via correspondence coding. Communicating trends and problems to Supervisor. Handling NSF not sufficient

**Why Kelly** **** **?**

Youre looking to keep your career moving onward and upward, and were here to help you do just that. Our financial staffing experts will connect you with premier companies for opportunities where you can learn, grow, and thrive. Jobs that fit your skills and experience, and most importantly, fit right on your path of where you want to go in in your career. It all adds up.

**About Kelly** ****

At Kelly, were always thinking about whats next and advising job seekers on new ways of working to reach their full potential. In fact, were a leading advocate for temporary/non-traditional workstyles, because we believe they allow flexibility and tremendous growth opportunities that enable a better way to work and live. Connecting great people with great companies is what we do best, and our employment opportunities span a wide variety of workstyles, skill levels, and industries around the world.

Kelly is an equal opportunity employer committed to employing a diverse workforce and providing accommodations for people with disabilities in all parts of the hiring process as required under its Employment Accommodation Policy. Kelly will work with applicants to meet accommodation needs that are made known to Kelly in advance.
Posted: 2020-11-20 Expires: 2020-12-21

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Claims Review Specialist

Kelly Services
Asheville, NC 28815

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