Insurance Follow-up Denials Specialist at Tennessee Retina MSO LLC in Nashville, Tennessee

Job Description:

Who We Are
Tennessee Retina is the largest Ophthalmology practice in middle Tennessee offering rewarding careers across 8 locations. We are committed to providing the highest level of care to our patients in the most convenient and caring manner. Our physicians are leaders in the research and application of new retina, macula, and vitreous treatments.

We are seeking an energetic and collaborative Insurance Follow-up/ Denials Specialist. The ideal candidate is responsible for performing day-to-day billing and follow-up on outstanding accounts receivable. Day-to-day activities may include all or some of the essential functions listed below depending upon individual experience/ knowledge and the needs of the organization which are subject to change from time to time.

This exciting opportunity will work closely and be supported by a team of colleagues, strong leadership, and cutting-edge technology! A day in the life of a Tennessee Retina employee is filled with learning, growing, creating, hard work, and, most of all fun!

Tennessee Retina offers a competitive salary based on diverse experiences and backgrounds.

Benefits Offered
Sign On Bonus, Certification Incentive Bonus, and Length of Service Award Bonus ProgramsContinuing Education ProgramTransportation Reimbursement ProgramEmployer-sponsored Medical, Dental, Vision, Critical Illness Coverage, Short-term, Long-Term Disability, & Employee Assistance Program401(k) with Generous Employer MatchHealth Savings Account (HAS) and Flexible Spending BenefitsPaid Holidays and Paid VacationAnnual Scrub Uniform AllowanceEmployee Referral Award Bonus ProgramSuccession, Growth, and Mentorship Opportunities
Social Gathering and Team OpportunitiesFull new hire training program to fully support, train, and welcome new hires to the team

Responsibilities
Utilizes the practice management system to perform follow-up on assigned outstanding accounts receivables. Receivables may include balances due from insurance and patient balances.Place phone calls to payers and/or utilize payer websites to resolve aged outstanding balance.Prepares and submits reconsiderations, appeals, medical record documentation request and correct claims as needed to ensure timely follow-up with all claims.Research denials and denial trends and notify Supervisor or Billing Manager when a trend is discovered offering account specific examples.Reviews all appropriate billing worklists as assigned within practice management system including zero pay denials, overpayments, fully worked receivables, holds, and manager holds.Researches, identifies, and rectifies any special circumstances resulting in delayed payments.Adhere to best practices standards in performing day-to-day follow-up tasks.The responsibilities listed are a general overview of the position and additional duties may be assigned.

Education, Training, and Experience
High School Diploma or GEDMinimum of 1 year of experience handling physician accounts receivable duties.Prefer candidates that are proficient in NextGen practice management system.Must have experience Preferred experience and knowledge reading and understanding of payer benefits. This includes differentiating between allowed charges, contractual adjustments, line-item denials/reasons, patient responsibility (co-pay, co-insurance, and deductibles), bundled payments, and understanding payer medical policy guidelines and protocols while utilizing these guidelines to manage authorizations effectively.Must be able to meet average expectations for productivity and quality standards.Prefer candidates that are proficient in utilizing MS-Excel for analyzing data using basic formulas, pivot tables, and charts.
Effective verbal and written communication skills with patients, physicians, management, employees, and the public.Excellent Organizational skills, multi-task, and logical thinkingKnowledge of Microsoft Office (Word, Outlook) and the ability to learn and adapt quickly to new software.Ability to be proactive, take initiative, and perform well in a fast-paced, high-volume practice.

Confidentiality
Maintains strict confidentiality regarding protected health information (PHI) and understands and adheres to TNRs HIPAA privacy and security policies and procedures.

Typical Physical and Working Demands
Position requires prolonged walking, sitting, some bending, stooping, and stretching. Good eye-hand coordination and manual dexterity are sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment is required. Employees must have a normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. Employees must have a normal range of hearing and eyesight to record and prepare paper and MDI chart notes and documents. Must be able to lift and carry up to 15 pounds.