About this role
At SCP Health, what you do matters As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care.
Why you will love working here: - Strong track record of providing excellent work/life balance. - Comprehensive benefits package and competitive compensation. - Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
Job Responsibilities:
• Review (AR (Accounts Receivable)) by payer daily to maintain or achieve reimbursement goals and days in AR. • Prepare timely appeals to overturn medical necessity, and various denials. • Provide regular feedback to management based on payer research and behavior trends. • Weekly feedback on payer/facility adjudication concerns. • Improve reimbursement outcomes and resolve outstanding claims inventory. • Identify the root cause of the non-payment and resolve the claim denial issue, including coding and billing errors, documentation issues and compliance discrepancies. • Maintain high productivity and quality of work. • Achieve a minimum score of 95% on all Quality Assurance audits. • Develop and execute effective appeals strategies to overturn denied claims. • Prepare and submit detailed and well-documented appeals to insurance companies within specified deadlines. • Possess knowledge of medical coding specific to professional emergency room and hospital medicine services. • Collaborate with coding specialists to address and rectify coding-related denial issues.
• Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services. • Collaborate with the medical billing team to address root causes of denials and implement preventive measures. Provide training to billing staff on denial prevention and resolution. • Meet production standards.
Knowledge, Skills, and Abilities:
• Understanding of the overall revenue cycle process through final account adjudication. • Excellent written and oral communication skills. • Strong interpersonal skills. • Meticulous and organized. • Ability to work effectively in a team environment. • Professional attitude and demeanor. • Initiative-taking and problem-solving skills.
Education (Required and/or Preferred):
• High School or Equivalent Required: Proven experience in denial management, specifically in professional emergency room and hospital medicine service.
Work Experience/Qualifications:
• 2+ years of experience in Medical Insurance Denials Management. • 2+ years of experience in customer service and patient billing within the medical industry. • Experience reading Explanation of Benefits (EOB’s) for Government, Commercial, PPO, HMO/IPA, and Workers’ Compensation payers. • Ability to review and validate credits to be refunded and validate recoupment demands. • Intermediate ability to assess and verify patient liability, coinsurance, deductibles, and denial codes. • Intermediate knowledge of MS Office. • Knowledge of ICD-9, ICD-10, CPT, HCPCS coding, and general claims processing practices. • 10-key by touch, Proficient in MS Excel, and Word. • Previous patient medical billing, OnBase, Centricity, and Way Star, Payor Portals experience a plus.
Primary Location:
• Dallas, TX Office (On Site 4 days a week / 1 day remote)
Pay Range: 18.00 - 26.00 USD per hourThis range represents the anticipated base salary for this role. Actual compensation will be determined based on experience, qualifications, and internal equity considerations. - We offer a comprehensive benefits package designed to support your health, financial well-being, and work-life balance, including medical dental, vision insurance, a 401(k) plan with a company match, paid time off and holidays, professional development support, and employee wellness resources. Visit our website for further information. https://myscpbenefits.com/ Login name: corp-guest Password: weheal