New job Account Representative II - Clinical Denials in Ohio

For this position on our Clinical Denials team, candidates with medical insurance experience are strongly preferred. While the position is 100% remote, only candidates residing in Northeast Ohio will be considered.

Responsibilities:

• Recommends and executes policies and procedures to the supervisor to ensure the timely resolution of patient service and third party reimbursement issues to foster an environment of total customer responsiveness.
• Performs customer service, insurance billing and follow-up processes for commercial and government payers, insurance verification, cash application, credit balance resolution and/or account reconciliation.
• Provides input to management obtained from various insurance companies, outside agencies and patients regarding reimbursement and customer service related issues.
• Recommends and executes changes to customer service programs in accordance with changes in insurance regulations from data obtained from various groups.
• Provides feedback to supervisor to assist the department liaison with various departments and physicians in regards to various issues including diagnosis coding. Complies and assists with the implementation of management reporting systems to ensure accurate and timely reporting of department goals and results.
• Assists with the development, implementation and execution of a quality control program for the timely and accurate resolution of patient and insurance inquiries.
• Other duties as assigned.

Education:

• High School Diploma or GED required.
• An Associate's degree may offset one year of the experience requirement.
• A Bachelor's degree may offset the two year experience requirement.

Certifications:

• None required.

Complexity of Work:

• Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Work Experience:

• Minimum two years of experience in a patient account or financial environment.
• An Associate's degree may offset one year of the experience requirement.
• A Bachelor's degree may offset the two year experience requirement.
• Knowledge of patient accounts which includes customer service, insurance processing, insurance verification and cash application.
• Knowledge of additional specialized function may be required such as third party payors, Medicare processing, hospital and physician billing and pricing, CPT4/ICD code application.
• Must have excellent verbal and communication skills.

Physical Requirements:

• Manual dexterity to operate office equipment.
• May require periods of sitting, standing and the ability to walk to various locations throughout the Foundation to attend meetings; must have normal or correction vision to clearly communicate verbally by phone or in person.

Personal Protective Equipment:

• Follows standard precautions using personal protective equipment as required.