About the job
As a pivotal member of our Revenue Cycle Management team, the Medical Claims Billing Specialist (Accounts Receivable Manager) is entrusted with ensuring the thorough and timely processing of medical claims. Reporting directly to the Director or Manager of Revenue Cycle Management, you will oversee the complete lifecycle of claims, proactively addressing inquiries from physician practices and managing correspondence efficiently. This role encompasses resolving escalated claim issues, ensuring a seamless integration with our SalesForce case management system, and collaborating with internal teams for optimal outcomes.
Key Responsibilities:
- Oversee accounts receivable management, analyzing aged AR to identify root causes and implementing error prevention strategies.
- Handle denial management by investigating sources, appealing decisions, and liaising with payer representatives.
- Make autonomous decisions regarding claim adjustments, resubmissions, and appeals to ensure prompt resolution.
- Coordinate with internal teams (Performance, Operations, Sales) and care center staff as necessary.
- Support large care center implementations, which may require occasional overnight travel.
- Collaborate closely with the Revenue Optimization team to align reimbursement processes with payer contracts, utilizing the Trizetto platform for denial analysis.
- Engage directly with practice consultants and physicians to enhance revenue cycle efficiency.
- Work towards meeting departmental Key Performance Indicators (KPIs) through a team-oriented approach.
- Perform other duties as assigned.