One of Atlanta’s top healthcare companies is looking for a underpayment contract representative.
- Ability to read & interpret a paper contract and apply the language to a claim
- Ability to manually calculate a claim based on contract language
- Keep up to date with contract updates
- Understanding of different insurance plans
- Calculate Stop Loss manually (1st Dollar & 2nd Dollar)
- Understanding of DRG, Carve Outs, Outliers, etc.
- Analyze accounts thoroughly to move the account to the next step of resolution
- Write an appeal for denied and/or underpaid accounts
- Review an EOB & determine the underpayment
- Contact the payer & able to provide a clear explanation on the claim issue to determine next steps
- Identify payer issues (track & trend)
- Clear & concise account notations that provides an explanation of what was done on the account, and next steps to be taken and what $ amount is being pursued that hasn’t been paid
- Decision making skills
- Work Over payments
- Determine when to escalate a claim issue
- Provide feedback than can assist staff & upper management
- Basic knowledge of Excel spreadsheets
MINIMUM EDUCATION REQUIRED:
High School graduate or GED equivalent.
Minimum Experience Required
At least two (2) years prior related healthcare Revenue Cycle experience, preferably within denials/underpayments.
Prior experience using Epic preferred.
If you have questions or need assistance, please contact Megan Lord