Location US-MI-Troy

ID 2024-4882

Category

Business Operations & Corporate

Position Type

Full-Time

Remote

No

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice.

Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care.

Our Shared Vision – Every patient deserves access to quality healthcare.

Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.

Why You Should Want to Work with Us

• Health, Dental, Vision, Disability & Life Insurance, and much more
• 401K Retirement Plan (with company match)
• Tuition, Professional License and Certification Reimbursement
• Paid Time Off, Holidays and Volunteer Time
• Paid Orientation and Training
• Great Place to Work Certified
• Established in 11 states
• Largest home-based primary care practice in the US for over 28 years, making a huge impact in healthcare today!

The Denial Management Specialist Lead, CNC & Specialty Programs is responsible for the optimal payment of claims for Centene and Wellcare Payers, along with any other payers within the Health Risk Assessment and Value Based Care programs. Primary duties include but are not limited to: Consistently following up on unpaid, underpaid & denied claims utilizing weekly aging reports, biweekly A/R report distribution to staff, value-based encounter denial follow up, filing appeals when appropriate to obtain maximum reimbursement, establish and maintain strong relationships with payers, monitor trends in denials and payment changes. Works closely with department manager to communicate claims issues to Specialty Programs Operations Team, Centene and Health Risk Assessment Teams. This position will be responsible for leading the team to resolve problems, as well as working with other departments on reimbursement challenges. (This person will need to live in or near Troy, MI and go into the office; specifically on Thursdays- once a week for collaboration meetings).

Essential Duties & Responsibilities

• Assist in facilitating training and onboarding experience for new hires
• Assist in creation/maintenance of Standard Operating Procedures
• Responsible for cross-training current team members or specialized training for projects
• Point of contact for issue resolution with the department
• Collaborate with other Revenue Cycle Management departments or Operational teams to resolve issues
• Assist in Compiling Productivity and Quality Measures
• Review Claims failed on Front End Edits due to various reasons; analyze the root cause
• Review and analyze insurance claims/encounters both in aged and denied AR for HarmonyCares Value Based and Centene plans
• Access denied claims from the worklist and query claim status with the payor, utilizing all appropriate systems & websites to effectively research the claim and resubmit or appeal as necessary
• Resolve for root cause denial reasons, reduce denial trending and communicate trends to management
• Assist the team in prioritizing claims based on aging and outstanding dollar amounts, or as directed by management
• Learn and understand internal/external operating systems to help staff navigate obstacles, including but not limited to: Centricity, EDI, Waystar, Various Insurance portals
• Regularly meet with supervisor to discuss challenges or billing obstacles as well as to provide status of outstanding aging reports
• Assist Management in submission and monitoring of Invoices to various plans through various processes
• Very strong MS Product background report heavy- Pivot tables- able to create Excel formulas.
  

Required Knowledge, Skills and Experience

• High School diploma or equivalent
• 5+ years of insurance follow up experience in a healthcare insurance environment and ability to multitask
• Computer experience is essential, including but not limited to: Microsoft products, with a heavy focus on MS Excel, Pivot Tables, PowerPoint, and SharePoint
• Ability to use critical thinking skills for troubleshooting staff questions/issues
• Knowledge of multi-specialty physician billing procedure guidelines according to Medicare, Medicaid, Commercial, and third-party payer policies and basic understanding of medical terminology, ICD and CPT codes
• Knowledge of value-based care model
• Experience in filing claim appeals with different payers to ensure maximum entitled reimbursement
• Ability to perform mathematical computations
• Skill in defining problems, collecting data and interpreting billing information
• Additionally, the ability to work effectively with staff, patients, public and external agencies
• Good customer service and telephone techniques required as well as a high level of confidentiality

Preferred Knowledge, Skills and Experience

• Associates degree
• Certification in Medical Billing/Coding
• Certified Revenue Cycle Representative (CRCR)

USD $31.18/Yr.

USD $25.68/Yr.

Individual compensation packages are based on various factors unique to each candidate, including skill set, experience, qualifications, and other job-related considerations.

HarmonyCares and HarmonyCares Hospice are not affiliated with Harmony Hospice Care. HarmonyCares Hospice does not conduct business in OH. HarmonyCares Hospice conducts business in MI, VA, WI, TX, IN, IL.

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