Commercial Insurance Collections Lead

Responsibilities

  • Collect on outstanding claims for MedRev healthcare clients, including national laboratories, DME, device manufacturers, hospitals, physician groups and surgical centers

  • Daily resolution of a high volume of outstanding claims

  • Efficient prioritization of outstanding claims: grouping similar claims, escalating as appropriate to internal, client and payer responsible parties

  • Identify bulk/group claim issues (e.g., coding/billing errors, incorrect payer denials, etc.)

  • Proactively communicate claim collections risks, issues, roadblocks

  • Perform account sampling to determine root cause issues resulting in payer underpayments and denials (including payer no response)

  • Research, develop and maintain an excellent understanding of industry and payer reimbursement requirements (authorization, coding, billing, timely filing, coordination of benefits, etc.)

  • Work remotely/independently with limited direct supervision

  • Supervise less experienced MedRev collections staff including: follow-up QA, guidance on claim resolution/next steps, managing workflow/prioritization, etc.

  • Work closely with internal resources and clients to expand MedRev expertise in client healthcare industries (laboratories, DME, device manufacturers, hospitals, physician groups and surgical centers)

  • Communicate clearly and effectively, both written and verbal, with payers, clients and internal resources

  • Effectively prioritize tasks/projects for self and less experienced collections staff, delivering high quality results while meeting established deadlines

  • Mentor and train less experienced MedRev collections staff

 

Requirements

  • Minimum 3 to 5 years collections experience within MedRev healthcare client industries: laboratories, DME, device manufacturers, hospitals, physician groups and surgical centers

  • Knowledge of MedRev healthcare client claim resolution processes: billing, collections/follow-up, payer appeals, denial management, etc.

  • Healthcare provider patient accounting systems experience such as Epic, XIFIN, Allscripts, Quadax, TELCOR, etc.

  • Experience with payer portals/adjudication systems (Availity, NaviNet, etc.)

  • Experience with software including Microsoft applications – Excel, Outlook, Word

  • Strong organization skills with understanding of healthcare provider financial and claims related data (billing forms, 835/837 EDI, etc.)

  • Track record and hands-on experience with significant positive results in the successful resolution of healthcare claims, maximizing payer cash collections

  • Knowledge and experience with payer denials including: incorrect/incomplete billing, coordination of benefits, non-participating provider, service/patient not covered, medical necessity, bundled charges, pre-cert authorization, investigational/experimental, etc.

  • Superior time management skill set; ability to effectively prioritize tasks and meet deadlines

  • Self-starter; ability to work both independently and in team environments

 

Preferred Qualifications

  • Experience with coding and claims scrubber systems

  • Data analysis experience including payer 276/277 claim status and 835/837 EDI

 

About MedRev Solutions

MedRev Solutions is a leading healthcare consultancy providing denials management, AR resolution and payment review and recovery (underpayment) services to healthcare providers nationwide.  Clients include national laboratories, DME, device manufacturers, hospitals, physician groups and surgical centers.

Utilizing MedRev services allows clients to realize significant cost/resource savings by automating appeal responses for large volumes of denied or unanswered insurance claims.  MedRev leverages client specific information to create customized algorithms and generate best in class denial response appeals.  Our proprietary software recognizes payer-specific reconsideration and appeal guidelines, layering provider/product-specifics and patient-specific clinical details to maximize insurance collections.

MedRev will quickly assess payer payment accuracy and denial data for large volumes of claims to identify patterns; findings can then be leveraged to bolster client operations and increase future internal client collections.

 Please submit resume to info@medrevsolutions.com