The posting
At SCP Health, what you do matters
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here:
- Strong track record of providing excellent work/life balance.
- Comprehensive benefits package and competitive compensation.
- Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
Job Responsibilities:
- Review (AR (Accounts Receivable)) by payer daily to maintain or achieve reimbursement goals and days in AR.
- Prepare timely appeals to overturn medical necessity, and various denials.
- Provide regular feedback to management based on payer research and behavior trends.
- Weekly feedback on payer/facility adjudication concerns.
- Improve reimbursement outcomes and resolve outstanding claims inventory.
- Identify the root cause of the non-payment and resolve the claim denial issue, including coding and billing errors, documentation issues and compliance discrepancies.
- Maintain high productivity and quality of work.
- Achieve a minimum score of 95% on all Quality Assurance audits.
- Develop and execute effective appeals strategies to overturn denied claims.
- Prepare and submit detailed and well-documented appeals to insurance companies within specified deadlines.
- Possess knowledge of medical coding specific to professional emergency room and hospital medicine services.
- Collaborate with coding specialists to address and rectify coding-related denial issues.
- Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services.
- Collaborate with the medical billing team to address root causes of denials and implement preventive measures. Provide training to billing staff on denial prevention and resolution.
- Meet production standards.
Knowledge, Skills, and Abilities:
- Understanding of the overall revenue cycle process through final account adjudication.
- Excellent written and oral communication skills.
- Strong interpersonal skills.
- Meticulous and organized.
- Ability to work effectively in a team environment.
- Professional attitude and demeanor.
- Initiative-taking and problem-solving skills.
Education (Required and/or Preferred):
- High School or Equivalent Required: Proven experience in denial management, specifically in professional emergency room and hospital medicine service.
Work Experience/Qualifications:
- 2+ years of experience in Medical Insurance Denials Management.
- 2+ years of experience in customer service and patient billing within the medical industry.
- Experience reading Explanation of Benefits (EOB’s) for Government, Commercial, PPO, HMO/IPA, and Workers’ Compensation payers.
- Ability to review and validate credits to be refunded and validate recoupment demands.
- Intermediate ability to assess and verify patient liability, coinsurance, deductibles, and denial codes.
- I have an intermediate knowledge of MS Office.
- Knowledge of ICD-9, ICD-10, CPT, HCPCS coding, and general claims processing practices.
- 10-key by touch, Proficient in MS Excel, and Word.
- Previous patient medical billing, OnBase, Centricity, and Way Star, Payor Portals experience a plus.
Certificates and Licenses:
None required.
Work Environment and Physical Demands:
- Professional setting.
- Continuous sitting.
- Continuous computer use.
- Occasional bending, kneeling, lifting, pulling, and pushing up to ten pounds.
- Elevated level of mental awareness.
Primary Location:
- Dallas, Texas
Confidentiality:
The daily activities of this position require strict confidentiality regarding individuals and strategic initiatives. Confidentiality must be maintained for all processed documents and information.
Compliance:
All Schumacher Clinical Partners employees will adhere to policies and procedures, including the Schumacher Clinical Partners Corporate Compliance Program, and comply with applicable local, state, and federal laws.
Disclaimer:
The above statements describe the essential functions of the job and may not include all work requirements. They are subject to change due to reasonable accommodation or other reasons.
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Pay Range:
18.00 - 26.00 USD per hour
This range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.
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We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources.
Visit our website for further information. https://myscpbenefits.com/
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