Allowables Representative

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What we Offer:

• Career Growth Opportunities
• A Culture anchored in a strong sense of belonging
• Benefits (Medical/Dental/Vision) begin the first of the month following 30 days of employment
• 401k (Discretionary match)
• Generous PTO
• 8 Paid Holidays
• Equipment Provided for Remote Roles

OVERVIEW:

The Allowables Representative will review monthly over-allowed and under-allowed variance reports to determine the cause of discrepancies for their assigned state(s). Representatives will follow up with carriers via websites or spreadsheets to review reimbursement discrepancies.

ESSENTIAL DUTIES & RESPONSIBILITIES:

• Runs specific payer underallowed reports for submission to carrier
• Reviews payer overallowed reports to verify if the claims are truly over paid or over contractualized
• May need to work with the Refund Department to verify the validity of an insurance refund request
• Runs queries to monitor progress
• Completes research form for submission to Managed Care department
• Follows up with Managed Care on any delinquent requests
• Consults with Sr. Allowables Representative or Allowables Manager for unusual circumstances that may include system data issues, payer responses, Managed Care delinquencies
• Other duties as directed by management

QUALIFICATIONS / EXPERIENCE:

• Minimum High School diploma or equivalent
• 2-3 years of medical billing experience
• Accounts Receivable, reading and interpreting explanation of benefits (EOB) is required
• Knowledge of Anesthesia physician billing policies and procedures is preferred
• Excellent analytical and organizational skills
• Ability to understand and interpret ambiguous contract language
• Able to work in a fast-paced environment under minimal supervision
• Able to work independently
• Excellent oral and written communication skills
• Knowledge of CPT and ICD-10 medical coding guidelines is preferred