Reconsideration Specialist

Job Id
206718
Job Location
Addison, TX
Employment Type
Full Time Regular
Industry
Health Care
Concentra
20220908T210612Z
Overview

Do you want to use your problem solving skills and knowledge of finance to help heal America's workforce? At Concentra, we serve more than 500 medical centers and 130 onsite clinics nationwide. Concentra colleagues remain fueled by our driving purpose: to provide outstanding patient experience by delivering the highest quality healthcare in an efficient, affordable, and caring manner. We do this by putting all customers first.

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Responsibilities

Position Summary

The Central Billing Office (CBO) Reconsideration Specialist analyzes and researches both denied or partially paid claims/invoices in order to resolve open accounts receivable. The position works from aging reports or system work queues to determine appropriate actions for either adjustment, or appeal with supporting documentation.

The Details

  • Review and analyze claim denials in order to perform the appropriate adjustment or appeals necessary for reimbursement to the company
  • Receive denied claims and research for appropriate appeal steps
  • Communicate directly with the payer. Resubmit appealable claims or charges that were inaccurately processed.
  • Help rack and document denials by payer and denial category
  • Identify, document, and communicate trends in recurring denials and recommend process improvements or system edits to eliminate future denials
  • Monitor short pay charges to assure appropriate reimbursement per payer contracts, or state regulatory compliance
  • Process appeals within deadlines as mandated by state specific fee schedules
  • Follow-up on all returned, denied or partially paid claims, ensuring rebills and appeals are mailed or delivered to achieve maximum reimbursement allowed
  • Work with customers or payers to resolve denials and get claims paid
  • Responsible for timely resolution of all claims, including corrected claims, appeals and communicating with appropriate parties on incorrect reimbursement
  • Escalate exhausted appeal efforts for resolution
  • Follow specific payer guidelines for appeals submission
  • Identify gaps in clinical documentation and work with leaders to develop and implement quality improvements
  • Analyze denial data and trends to share findings with revenue cycle leadership and drive process improvements
  • Validate denial reasons and ensures coding is accurate for appeals when necessary
  • Research contract terms and compile necessary supporting documentation for appeals
  • Perform research and make determination of corrective actions and takes appropriate steps with approved adjustments or appeals to recover revenue
  • Communicate to management regarding incorrect reimbursement issues Concentra is a national health care company focused on improving America’s workforce, one patient at a time. Through our affiliated clinicians, we provide occupational medicine, urgent care, primary care, physical therapy, and wellness services. Concentra also serves employers by providing a broad range of onsite health services in worksite medical facilities. Date Approved: 10/19/2021 Revision Date: 10/19/2021
  • Apply appropriate adjustments per contracts or state requirements
  • Process all reconsiderations with the appropriate state reports, transcription, and explanation of benefits (EOB's)
  • Follow-up on all previously sent reconsiderations for proper payment
  • Monitor process of short/zero payments for reconsiderations
  • Verify proper adjustments were processed
  • Work payer projects as necessary
  • This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

 

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Qualifications

Education/Credentials

  • High school diploma or GED equivalent
  • Specialty job training in medical billing preferred

Job-Related Experience

  • Customarily has at least two years of experience in medical billing or collections

Job-Related Skills/Competencies

  • Concentra Core Competencies of Service Mentality, Attention to Detail, Sense of Urgency, Initiative and Flexibility
  • Ability to make decisions or solve problems by using logic to identify key facts, explore alternatives, and propose quality solutions
  • Outstanding customer service skills as well as the ability to deal with people in a manner which shows tact and professionalism
  • The ability to properly handle sensitive and confidential information (including HIPAA and PHI) in accordance with federal and state laws and company policies
  • Excellent communication skills
  • Excellent organizational skills
  • Excellent attention to detail
  • Ability to work in fast-paced environment
  • Ability to work independently
  • Ability to assist peers and train new employees
  • Ability to handle special projects
  • Ability to meet with payors and present concerns regarding reimbursement issues
  • Ability to handle multiple duties and priorities
  • Clear understanding of worker's compensation reimbursement guidelines and regulations
  • Working knowledge of medical CPT/HCPCS and Diagnosis Coding
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Benefits

Employee Benefits

  • 401(k) Retirement Plan with Employer Match
  • Medical, Vision, Prescription, Telehealth, & Dental Plans
  • Life & Disability Insurance
  • Paid Time Off & Extended Illness Days Offered
  • Colleague Referral Bonus Program
  • Tuition Reimbursement
  • Commuter Benefits
  • Dependent Care Spending Account
  • Employee Discounts

This job requires access to confidential and critical information, requiring ongoing discretion and secure information management.

We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.

Concentra is an Equal Opportunity Employer, including disability/veterans

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