Risk Adjustment Coding Specialist supporting risk adjustment efforts through chart reviews and provider education. Estimated travel up to 75% in Inland Empire region, specifically LA or Orange County.
About the role
- Accounts Receivable Specialist resolving accounts receivables in a physician office setting for opioid treatment organization. Utilizing industry knowledge to ensure timely payments and compliance with regulations.
Responsibilities
- Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies
- Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, credits, etc.
- Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions, document all activity in accordance with organizational and client policies
- Communicate professionally (in all forms) with payer resources to include websites/payer portals, e- mail, telephone, customer service departments, etc.
- Maintain quality and productivity results at a level that meets departmental standards as measured by a daily/weekly/monthly average
- Reviews claims data and supporting documentation to identify coding and/or billing concerns
- Ability to interpret payer contracts and identify contract variances affecting reimbursement
- Utilize knowledge of the cash posting processing to obtain the necessary information to resolve misapplied payments
- Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers
- Interpret claim scrubber edits/rejections and takes appropriate action necessary to resolve issues
- Seek resolution to problematic accounts and payment discrepancies
- Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution
- Analyze accounts with critical thinking; consider payer contracts and billing guidelines to ensure one-touch resolution
- Further responsibilities may include reviewing insurance credit balances to determine root cause and take the steps necessary to resolve the account
- Identify denials trends, root cause, and A/R impact
- Serve as a resource to other team members and assist Team Leads with identifying A/R and denials trends
- Other Duties as Assigned.
Requirements
- Must have had at least 2 years accounts receivable experience in a physician office setting
- General Knowledge of HCPCS, CPT-4 and ICD-10 coding and/or medical terminology
- Familiar with multiple payer requirements and regulations for claims processing
- Must have a High School Diploma/GED.
Benefits
- Have a daily impact on many lives
- Excellent training if you are new to this field
- Mileage reimbursement (if applicable) Crossroads matches the current IRS mileage reimbursement rate
- Community events that promotes belonging and education
- Includes but not limited to community cook outs, various fairs related to addiction treatment and outreach, parades, addiction awareness for schools, and holiday events
- Opportunity to save lives everyday!
- Medical, Dental, and Vision Insurance
- PTO
- Variety of 401K options including a match program with no vesture period
- Annual Continuing Education Allowance (in related field)
- Life Insurance
- Short/Long Term Disability
- Paid maternity/paternity leave
- Mental Health day
- Calm subscription for all employees
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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