RCM AR Specialist

What you will do:

• Review denied claims based on assigned markets, payers and work queues within our practice management system
• Accurately and efficiently processes requests for denied claims information using website portals and outbound phone calls for all Commercial, Medicare and Medicaid insurance payers
• Researches and responds to documentation requests from insurance carriers in a timely manner
• Processes appeals of insurance denials and follows-up until the appeal is resolved
• Obtains, reviews and updates patient demographics and insurance information within both EHR and practice management billing system as needed
• Complete timely follow-up on claims submitted to payer, but no response or ERA after 45 days to resolve any pending issues with claim and payer within timely filing limits
• Documents clear and concise activities performed in the system for each account worked
• Adheres to all HIPAA (Health Insurance Accountability and Portability Act) guidelines and regulations
• Ability to consistently maintain productivity and quality expectations as defined by the leadership team
• Alert management to irregularities, insurance trends and areas of concern with reimbursement
• Completes other tasks and projects as assigned by RCM Leadership

You are a good fit if you have:

• Bachelor's Degree or Equivalent experience 
• 3 or more years of experience in physician group practice in a denial management role 
• Prior experience resolving out of network denials, and value based (bundle) claims
• Proficient in CPT and ICD-10 coding terminology
• Enjoy working in a fast paced and rapidly changing environment
• Strong relationship building skills both external and internal
• Thrive on  working  independently

It will also be great if you have:

• Familiar with opioid use disorders, substance abuse use disorders and other areas of behavioral health billing
• Certified Medical Coder, CPC or CCS, preferred but not required
• Deep knowledge of medical insurance payers and regulations
• Knowledgeable in the healthcare & mental health industries - terminology, regulations, and processes
• Familiar with all aspects of the RCM Life cycle as it relates to claim reimbursement

Work location requirements:

• BLP operates in hybrid and remote work environments, which allows us to better meet our members and partners where they’re located. Candidates applying for this role must be willing and able to travel locally within the communities we serve and/or travel to onsite meetings as expected in coordination with their department and business needs.  

When working from home, the requirements include:

• Must have reliable internet service with a fast upload/download ability
• Ability to ensure any protected health or proprietary data/information is not visible (or audible)  to others in any work location
• Must have a quiet space to speak to members, team members, or external partners with minimal background noise and distractions