Electronic Denial Associate

MED3OOO is one of the largest national healthcare management and technology companies devoted to making healthcare a better place for physicians to practice and patients to receive care.  We offer proven solutions to physician groups, provider networks, and EMS ambulance organizations to allow them to reach their highest levels of operational, financial and clinical outcomes.

 

At MED3OOO, many different individuals contribute to meeting our company goals and achieving success including employees in Accounting, Administrative, Billing & Revenue Cycle Management, Practice Management, Coding & Compliance, Training, Project Management, Account Management, Physician Operations, Managed Care Operations, IPA Management & Operations, Human Resources, Information Systems, Sales & Marketing; and EMS Ambulatory Billing.

 

Position Summary:

An Electronic Denial Associate’s overall responsibility is to ensure that every electronic claim is making it to the payer and that payment is being received on a majority of the accounts within each run.  This will include balancing each run, working rejections daily, monitoring any formatting/run issues closely, and validating payment(s) or rejections(s). 

 

Responsibilities:

· Balancing EDI spreadsheet.

· Work Edit reports via task management on a daily basis.  There are separate queues for each format.

· Process E1 second level rejections via TrackEdi and process all other formats via paper and/or image daily.

· Work accounts found on the scrubber report and rejection queue.

· Open EDI work orders for reports missing after 72 hours of the files being sent for both 997’s and second levels.

· Contact carriers on an as needed basis to resolve the more difficult rejections.

· Assist in working the QC Claim Delay custom and QC Claim group report on a monthly basis.

· Commenting all actions taken on all accounts.

· Work with fellow staff members and other offices to expedite carrier, format, and/or run issues.

· Communicate any potential problems/issues with management to avoid any decrease in cash flow.

· Work with EDI programmers to resolve any format issues.

· Work with BTC Coordinator to setup rules in the BTC.

· Validate through the Emdeon website all commercial carriers that can go electronic and cross reference the billing system monthly.

 

Requirements:

· Excellent problem-solving and communication skills.

· Minimum of 8,000 keystrokes per hour with minimal errors.

· Microsoft office skills are preferred.

· Knowledgeable for using websites for eligibility, claim status and payer updates.

· Productive and efficient to meet 24-48 hour turnaround time.

· Must be able to work independently and within a team under the direction of the Operations Manager.

· Knowledge of insurance carrier denials.

· Must be flexible and capable of working under time constraints that may create stressful conditions.

· Proficient in prioritization, organization and follow-up skills.

 

We offer a full range of benefits including health, dental, vision, long-term disability, short-term disability, life insurance, 401(k), FSA’s and paid time off. 

Qualified candidates should submit a resume and cover letter, including salary history to the contact listed below.