Job Details

We are looking for the brightest and the best to join our team!

Two major benefits offered by Cure 4 The Kids Foundation

• One of the most competitive compensation and comprehensive benefit packages in the field of healthcare
• A state?of?the?art clinical and administrative environment located at 215 and Town Center, Summerlin on the Roseman University Campus

Cure 4 The Kids Foundation was voted #10 on the list of the 50 Best Non?Profits to Work for in The U.S.

What It Takes To Be Part Of Our Team

Are you an exceptional Patient Account Representative who absolutely thrives on being part of an accountable team? Can you dedicate yourself to being part of a team serving the needs of children and their families? Do you bring the highest standards of integrity and professionalism to your team? Do you thrive in an environment where you are valued and appreciated for who you are, how hard you work and for that something special you bring to the teams you choose to work with? Are you looking for an organization that offers competitive compensation and one of the broadest and most comprehensive benefit packages available in the field of healthcare?

This is a role that requires a multi-disciplinary team approach to solving problems and patient challenges. "That's not my job" or "someone else can do it" is not in our team vocabulary because we are here to be of support to each other. The primary goal is to bring the best patient care and experience for our area's children.

Position Description

Responsible for contacting payers to collect insurance payments and resolve denied claims by initiating claims appeals and following escalation protocols. This is a non?exempt, hourly position.

Essential Duties And Responsibilities

• Follows up and reports the status of insurance accounts for assigned payers, adhering to the Collection Queue Priority Matrix. Documents each collection action with clear notes including current claim status, denial reasons, actions taken, and follow?up dates.
• Performs various insurance collection activities including contacting payers, coordinating with the Medical Billers to correct and resubmit claims, and submitting medical records upon request.
• Prepares and files claim reconsiderations and appeals.
• Attends meetings with insurance provider relation representatives. Foster a professional relationship with designated representatives and escalates appropriate claims for resolution.
• Reviews and corrects rejected electronic claims in Payerpath clearinghouse.
• Submits secondary claims with the primary insurance Explanation of Benefits and medical records.
• Identifies and reports denial and error trends through preparation and analysis of payer?specific or other A/R analytic reports. Reports denial trends to the team through weekly meetings to discuss resolutions.
• Collaborates with the Patient Financial Counselors and other departments to investigate and request reprocessing for claim and payment processing errors.
• Submits Write?off and adjustment requests (WARs).
• Investigates and submits refund requests for insurance overpayments. Submits appeals to payers disputing refund if appropriate (RR).
• Maintains the strictest confidentiality; and adheres to all HIPAA guidelines/regulations.
• Prepares payer?specific or other claim denial analytic reports as directed by supervisor.
• Performs other duties as assigned.

SUPERVISORY RESPONSIBILITIES

None.

Required Education And Experience

• Associate degree or two (2) years of experience in insurance collections with a high school diploma or GED.
• Previous work?related skill, knowledge, or experience.

Preferred Education And Experience

• Insurance collection experience in oncology, hematology, orthopedics, and Rheumatology.

Knowledge, Skills, And Abilities

• Excellent organization and time management skills along with excellent verbal and written communication skills.
• Familiarity with Microsoft applications (including, but not limited to Word and Excel).
• Knowledge of medical billing/collection practices.
• Knowledge of basic medical coding and third?party operating procedures and practices.
• Understanding of medical terminology and insurance laws/guidelines.

Physical Demands And Work Environment

• Prolonged periods sitting at a desk and working on a computer.
• Occasionally required to walk or stand.
• Frequently required to utilize hand and finger dexterity.

LANGUAGE SKILLS

English

CURE 4 THE KIDS FOUNDATION PARTICIPATES IN E-VERIFY.

Shift Schedule

Monday-Friday, 8:00 a.m. to 4:30 p.m.