Payment Recovery Specialist - Out of State Billing (Medicaid) - Fully Remote! - Centauri Health Solutions : Job Details

Centauri Health Solutions provides technology and technology-enabled services to payors and providers across all healthcare programs, including Medicare, Medicaid, Commercial and Exchange. In partnership with our clients, we improve the lives and health outcomes of the members and patients we touch through compassionate outreach, sophisticated analytics, clinical data exchange capabilities, and data-driven solutions. Our solutions directly address complex problems such as uncompensated care within health systems; appropriate, risk-adjusted revenue for specialized sub-populations; and improve access to and quality of care measurement. Headquartered in Scottsdale, Ariz., Centauri Health Solutions employs 1700 dedicated associates across the country. Centauri has made the prestigious Inc. 5000 list since 2019, as well as the 2020 Deloitte Technology Fast 500 list of the fastest-growing companies in the U.S. For more information, visit www.centaurihs.com.

Role Summary:

The Payment Recovery Specialist reviews claims to make sure that payer specific billing requirements are met, follows-up on billing through payment of the claim, answers inquiries, and updates accounts as necessary. The Payment Recovery Specialist is responsible for analysis of denied reimbursement claims and ensures appropriate insurance coverage for compliance standards and revenue generation. The Payment Recovery Specialist coordinates with departments and insurance companies to correct errors as necessary.

Role Responsibilities:

* Resolves billed claims and referred denials

* Runs reports to determine upcoming workload

* Performs initial contact (phone, web portal) with payers to validate claim status and reason for denial.

* Extracts data from client patient accounting system necessary to resolve denied claims

* Documents account activity in both the Human Arc and client operating system (posts, dispos, notes, status, etc.)

* Sorts through and takes appropriate action on incoming client correspondence from insurance companies

* Requests and obtains medical records from client or other documentation from physicians offices to resolve denied claims

* Requests additional information as needed from clients, physicians and/or related providers and patients to resolve denied claims

* Issues appeal letters on non-clinical denials

* Follows up with patient for additional information

* Follows up on all appeals, payments and denials, bringing accounts to resolution with both payer and client

* Communicates pertinent client and payer trends to the Team Leader

* Review payment accuracy for final disposition of account

* Performs filing/scanning as needed on assigned accounts

* Communicates pertinent client information regarding procedures, project status to Team Leader

* Accountable for meeting established productivity measures and goals

* Participates in special projects as assigned

Role Requirements:

* Knowledge of and experience with Hospital Patient Accounting systems; language, flow of work, processes, and procedures

* Strong knowledge of insurance types and associated administrative guidelines for each

* Understanding of hospital revenue cycle and insurance payment methodologies

* Billing process and procedures (including parameters and requirements of billing)

* Electronic billing software

* Understanding of insurance contracts and terminology

* Knowledge of State policies/procedures on determining eligibility and claims processing

* Basic understanding of appeals/denial resolution processing needs

* Strong communication skills and problem-solving ability

* Strong analytical, project planning and organizational skills

We believe strongly in providing employees a rewarding work environment in which to grow, excel and achieve personal as well as professional goals. We offer our employees competitive compensation and a comprehensive benefits package that includes generous paid time off, a matching 401(k) program, tuition reimbursement, annual salary reviews, a comprehensive health plan, the opportunity to participate in volunteer activities on company time, and development opportunities. This position is bonus eligible in accordance with the terms of the Company's plan.

Centauri currently maintains a policy that requires several in-person and hybrid office workers to be fully vaccinated. New employees in the mentioned categories may require proof of vaccination by their start date. The Company is an equal opportunity employer and will provide reasonable accommodation to those unable to be vaccinated where it is not an undue hardship to the company to do so as provided under federal, state, and local law.

Factors which may affect starting pay within this range may include geography/market, skills, education, experience and other qualifications of the successful candidate.

This position is bonus eligible in accordance with the terms of the Company's plan.

Other details

* Pay Type Hourly

* Min Hiring Rate $18.00

* Max Hiring Rate $23.00

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* New Mexico, USA