Patient Account Representative - Central Denials Unit

Job Family:

Patient Account Representative

Travel Required:

None

Clearance Required:

None

What You Will Do:

The Central Denials Account Representative conducts thorough account reviews to determine the appropriate action needed to resolve the account balance. Review and resolve claim denials for payment or adjustment. Contact payers via phone call and portal, identify issues with claims and make corrections as needed or sending to appropriate department for review. Follow up on authorizations, claims and appeals with payers. Interact with other departments and work to mitigate and prevent claim denials. This includes reviewing and performing the following:

• 227 Electronic Files

• 835 Electronic Files

• UB04’s and 1500 Claim Files

• Medical Record

• Making outbound calls to Insurance Companies to resolve claim denials and account balances.

• Performing Non-Clinical Appeals.

• Assisting Supervisor/Manager as needed with various projects.

• Escalate payer issues/trends to a supervisor with the appropriate information or take appropriate action so that the issue expert can effectively resolve the matter.

• Communicate to Supervisor/Manager areas of concern or areas of improvement.

• Resubmit Corrected Claims and supporting documentation as need for the patient experience.

• Communicate with other organizational departments to ensure proper handling of patient accounts.

• Communicates issues to management timely and performs other duties as assigned by direct supervisors.

• Perform a variety of duties often changing from one task to another of a different nature without loss of efficiency or composure.

What You Will Need:

• HS Diploma or equivalent.

• 0-2 years medical billing and/ or payer experience working with UB04, appeals & denials.

• Ability to initiate and follow through on projects and work independently with minimal supervision required.

What Would Be Nice to Have:

• Previous Denials Experience

• Knowledge CARC Codes

• Payer Knowledge

 

What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

• Medical, Rx, Dental & Vision Insurance

• Personal and Family Sick Time & Company Paid Holidays

• Position may be eligible for a discretionary variable incentive bonus

• Parental Leave

• 401(k) Retirement Plan

• Basic Life & Supplemental Life

• Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

• Short-Term & Long-Term Disability

• Tuition Reimbursement, Personal Development & Learning Opportunities

• Skills Development & Certifications

• Employee Referral Program

• Corporate Sponsored Events & Community Outreach

• Emergency Back-Up Childcare Program

About Guidehouse

Guidehouse is an Equal Opportunity Employer–Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com.  Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse.  Note that Guidehouse will never charge a fee or require a money transfer a