Job Description

We are, a freestanding, physician-owned, comprehensive cancer center based in Albuquerque, NM with a satellite clinic in Gallup, New Mexico. We are an Oncology Medical Home, with a focus on early intervention for patient symptoms, resulting in low hospitalization rates. Our Physicians have won Top 10 Docs in the city of Albuquerque multiple times.

As a successful Medical oncology and Radiation oncology practice, we have expanded our medical practice to include Survivorship, palliative care, Primary Care, Rheumatology, Pulmonary, Urology, and Neurology.

Make a difference in the lives of patients by joining a physician-led, partnership organization with a patient-centered and evidenced-based medicine approach. You will have the tools, resources, and professional freedom you need to deliver outstanding patient care.

POSITION SUMMARY:

The Medical Claims Appeals Specialist is responsible for tracking and resolving outstanding payment issues and generates weekly aging reports in a timely manner. The Medical Claims Appeals Specialist should display a positive and proactive attitude, strong organizational skills, and the ability to prioritize and multitask and be a strong communicator, both paper and over the phone, in performing these duties that help the organization achieve its mission, vision while demonstrating and adhering to the core values.

ESSENTIAL FUNCTIONS:

Reasonable Accommodations Statement:

To perform this job successfully, an individual must be able to perform the essential duties satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions.

Essential Functions Statement(s):

Maintains and audits all accounts receivables/credits over 45 days old on at least a monthly basis documenting notes for productivity. Communicates effectively with other billing staff on improvements for billing primary and secondary claims. Reviews insurance EOB's for possible processing errors. Responds to denials and requests/correspondence for more information within a two day time period. Reviews of accounts to ensure accounts billed in Centricity (sent out to payer). Reviews of accounts to ensure accounts are received by payer and either processed or in process after 30 days from date of filed. Ensures balances are accurately designated between insurance and patient. Assists patients with questions on the phone or face to face. Researches credit balances for specific insurances assigned. Assists in education of other staff specific to payers assigned. Be the representative for specific payers for the organization. Reviews patient's newly scanned insurance cards and notifies the insurance verification representative of any discrepancies. Reports any claim issues to manager.

POSITION QUALIFICATIONS:

Competency Statement(s):

Active Listening - Ability to actively attend to, convey, and understand the comments and questions of others. Adaptability - Ability to adapt to change in the workplace. Analytical Skills - Ability to use thinking and reasoning to solve a problem. Applied Learning - Ability to participate in needed learning activities in a way that makes the most of the learning experience. Communication - Ability to communicate effectively with others using the spoken and written word. Customer Oriented - Ability to take care of the internal and external customer's needs while following company procedures. Initiative - Ability to make decisions or take actions to solve a problem or reach a goal. Judgment - The ability to formulate a sound decision using the available information and resources. Strong business and political acumen. Organized - Possessing the trait of being organized or following a systematic method of performing a task and/or presenting material. Problem solving--the individual identifies and resolves problems in a timely manner and gathers and analyzes information skillfully. Safety/Compliance Awareness - Ability to identify and correct conditions that affect employee/patient safety and privacy compliance.

SKILLS & ABILITIES:

Education and Experience:

High School Graduate or General Education Degree (GED). One - Two years related experience. Knowledge of CPT/HCPCS/ICD-10 codes.

Computer Skills:

Intermediate computer skills, Microsoft Office, Billing Software

Compensation/Benefits:

Competitive Salary D.O.E. Generous Benefits Package
Job Type: Full-time

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Vision insurance
Work Location: In person