Account Assistant 4

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$31.83

Under the direction and supervision of the Supervisor and Team Lead/Manager, employee will be responsible for insurance follow-up on carrier denials, no insurance response and claim edits for Yale Medicine. Employee will function as a liaison in the day to day follow-up of denied, no response claims and claim edits to obtain maximum reimbursement for services rendered by Yale Medicine and other related practices.

Follow up of denied and no insurance response for Yale Medicine and its related specialties and practices. Oversees maintenance of account files ensuring accuracy and completeness. Review payment history. Review, work and resolve problem and delinquent accounts with supervisor and collection agency. Recommend and implement changes to system and operation procedures. Compose form letters and correspondence used in account receivable activities.

Researches individual accounts. Follow up of denials according to the rejection code posted in Epic and follow process guidelines established by the Central Business Office management team. Process and review carrier denials for adherence to specific payer Explanation of Benefits. Work collaboratively with YM staff to ensure maximum reimbursement. Directly communicate with third party insurance carriers, patients, and other listed payers in order to investigate payment/reimbursement delays for billed charges, for both primary and secondary claims.

Respond to requests from insurance carriers, Yale Medicine clinical departments and/or patients for supporting documentation necessary in order to obtain maximum reimbursement. Work closely with other centralized and non centralized units within the Business Office to resolve outstanding claim/billing/payer issues or requests. Identify and report carrier/specialty issues that will assist in claim processing and resolution. Responsible for documentation and follow up of claims worked through payment, rejection or claim edits.

Strong knowledge of insurance carrier and specialty related issues. Review and validate charge review and claim edits as assigned to ensure correct coding, billing guidelines and in compliance with Yale Medicine guidelines. Special projects as assigned by Yale Medicine staff and management and all other job related duties.

• Healthcare Revenue Cycle Knowledge:
  Understanding of healthcare revenue cycle operations, insurance billing, claims processing, eligibility, reimbursement, and denial management. Knowledge and working experience with CPT, ICD
  10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edit’s (MUE’s).
• Denial and Claim Resolution:
  Ability to research, analyze, resolve, and/or appropriately escal
• Billing System and Workflow Proficiency:
  Ability to navigate billing systems, work queues, patient accounts, claim details, payer information, and related revenue cycle workflows. Highly energetic and motivated with the ability to work under pressure and handle and maintain a high volume of accounts.
• Analytical and Problem-Solving
  
  Skills:
  
  Ability to analyze claim and denial information, identify the cause of issues, determine appropriate resolution, and apply knowledge of payer requirements and billing guidelines.
• Communication and Organization: Strong written and verbal communication skills with the ability to manage multiple priorities, meet productivity expectations, work independently, and collaborate effectively with internal departments, liaisons, and insurance payers.

• Complex Denial and Appeal
  
  Experience:
  
  Experience managing complex or high-dollar denials, appeals, payer disputes, and identifying recurring denial trends and root causes.
• Revenue Cycle Technology
  
  Experience:
  
  Experience with Waystar or other clearinghouse and payer portal systems, claim edits, electronic claims, eligibility tools, and other revenue cycle applications.
• Process Improvement: Demonstrated ability to identify workflow issues, recommend process improvements, reduce recurring denials, and improve clean claim performance.
• Professional…