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Denials Resolution Representative in Knoxville, TN - Maryville, TN - Alcoa, TN at TeamHealth

Date Posted: 8/9/2018

Job Snapshot

Job Description

Join a team of dynamic, results oriented professionals!

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Convenience market on site
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Business casual dress code
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

This position is responsible for reviewing remittances with Medicaid, Medicare, TennCare, Blue Cross Blue Shield denials at their assigned Billing Group. Maintains accuracy and production to ensure remittances are being processed effectively.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Reviews EOB's and enters rejection codes, financial comments, and rebills claim as necessary.
  • Reviews denials to determine appropriate action based on carrier requirements.
  • Assembles and forwards documentation to appeal disputed claims.
  • Contacts Medicare, Medicaid, TennCare and Blue Cross Blue Shield to inquire on           unpaid claims in the Appeal FSC.
  • Contacts Managed Care carriers to inquire on unpaid claims in the Appeal FSC.
  • Handles correspondence related to Medicaid, Medicare, TennCare, and Blue Cross Blue Shield according to written procedure.
  • Assembles and forwards appropriate documentation to the senior representative for provider related issues.
  • Reviews Medicaid, Medicare, TennCare, and Blue Cross Blue Shield provider manuals and updates.
  • Reports any consistent errors found during review that affect claims from being processed correctly.
  • Participates in unit progress meetings with Denials Resolution Team.
  • Turns to supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
  • Performs any and all duties as directed by Senior Representative, Supervisor and Manager.

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Education equivalent to the completion of the 12th grade with two years experience in a medical billing setting with primary emphasis on Government programs, such as Medicare, Medicaid, Indigent Care, etc.

SUPERVISORY RESPONSIBILITIES:

  •  None

PHYSICAL / ENVIRONMENTAL DEMANDS:

This job should be performed in a well-lighted and well-vented environment. Requires constant sitting tolerance. Extended amount of time spent in front of computer display terminal.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.