UR Solutions is a minority-owned medical solutions firm with extensive experience in inpatient and emergency room utilization review, denials management, and administrative third-level appeals. UR Solutions also provides clients with unmatched actuarial advising aimed at maximizing efficiency and revenue.
Full time position to work in our insurance/appeals departments. Three (3) years of Experience preferred. Will be responsible for both telephone and computer work. Please send resume with salary requirements.
Knowledge of Midas, EPIC, Meditech or Powerchart a Plus
Telephones third-party payors who have not resolved, appeals or other claims related issues in a timely manner. Uses written follow-up to third-party payors as necessary. Responsible for learning and applying follow-up techniques for all third-party payors. Request rebilling of claims as needed.
SKILLS & QUALIFICATIONS
- High school graduation required and bachelors degree preferred
- Requires basic working knowledge of insurance payer’s billing, and appeal practices.
- Ability to obtain payer specific details, as necessary, and is able to complete additional payer billing as needed.
- Excellent communication and interpersonal skills.
- Excellent organizational skills to manage multiple tasks in a timely manner.
- Proficient uses of hospital practice management systems, personal computers as well as spreadsheet and word processing applications (Microsoft Excel and Word).
- Requires some knowledge of medical terminology.
- Candidate must have experience working with multiple MCO, Medicare, and Medicaid Insurance companies
- Be able to answer calls inbound, make outbound calls
- Provide thorough, efficient, and accurate account notes on computer files for each call made or received.
- Knowledge, understanding, and compliance with all applicable Federal, State, and Local laws and regulations that regulate the collection industry, such as the FDCPA and HIPAA.
- Works with clinicians to perform analyses related to appeals, health information, and health resource utilization.
- Highly skilled in data analysis, reporting and formulating recommendations.
- Maintains databases to track business performance. Analyzes data and summarizes performance.
- Experience with relational databases and knowledge of query tools and statistical software is preferred.
- Strong analytical, organizational, presentation and problem solving skills.
- Perform other duties as assigned by management.