"Acct Assistant 4 - Specialty Rejections F/U"

Overview

Under the direction and supervision of the Associate Director and Team Lead/Manager, employee will be responsible for insurance follow-up on denials from Yale Health Plan, Workers Compensation and MVA payers as well as charge review, credit and claim edit work queues. Follow up of denied claims for Yale Medicine and its related specialties and practices. Follow up denials, resolve claim edits and credits for assigned payers following process guidelines established by the Central Business Office management team. Review carrier denials or letters to analyze next steps needed to ensure payment. Review payment history. Review, work and resolve delinquent accounts with supervisor and collection agency. Recommend and implement changes to system and operation procedures. Compose form letters and correspondence used in account receivable activities. Knowledge of appealing denials in order to receive maximum reimbursement for Yale Medicine. Write, send and follow up on appeals as appropriate by contacting the carrier, researching carrier policies, review of medical documentation and/or work collaboratively with YM staff to ensure maximum reimbursement. Directly communicate with third party insurance carriers, patients, and other listed payers in order to investigate payment/reimbursement delays for billed charges, for both primary and secondary claims. Respond to requests from insurance carriers, Yale Medicine clinical departments and/or patients for supporting documentation necessary in order to obtain maximum reimbursement. Work closely with other centralized and non centralized units within the Business Office to resolve outstanding claim/billing/payer issues or requests. Identify and report carrier/specialty issues that will assist in claim processing and resolution. Responsible for documentation and follow up of claims worked through payment, rejection or appeal. Strong knowledge of insurance carrier and specialty related issues. Review and validate charge review and claim edits as assigned to ensure correct coding and in compliance with Yale Medicine guidelines. Ability to review and understand medical records and coding. Interact with all Yale Medicine departments as required to resolve matters relevant to coding, fees, medical documentation and other problems to expedite the processing of claims, payments and rejections. Special projects assigned by Yale Medicine staff and management and all other job related duties.

Required Skills and Abilities

1. Knowledge and working experience with CPT, ICD10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edit’s (MUE’s).
2. Working knowledge and experience with Microsoft Office especially Excel and Word.
3. Working experience of EPIC and EPIC work queues. PC data entry experience.
4. Ability to work independently and part of a team. Ability to multi-task in a high-volume environment. Strong verbal and written communication skills.
5. Excellent attendance and reliability. Must be highly energetic and motivated with the ability to work under pressure and handle and maintain a high volume of accounts.

Preferred Education, Experience and Skills

Experience resolving worker’s compensation & motor vehicle accident claims & rejections including corresponding with those payers as well as attorneys.

Principal Responsibilities

1. Serves as a principal source of information on rules and procedures governing University accounts receivable. Oversees and instructs support staff.
2. Oversees maintenance of account files, ensuring accuracy and completeness. Reviews payment histories.
3. Resolves problem and delinquent accounts with supervisor and collection agency. Assists with final review and disposition of problem accounts.
4. Recommends and implements changes to systems and operating procedures. Composes form letters and correspondence used in accounts receivable activities.
5. Researches individual accounts. Summarizes findings in reports. Completes and processes forms. Performs clerical functions incidental to account activity.

Required Education and Experience

Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate's degree, or an equivalent combination of experience and education.

Hourly Range

31.05