AR/Denials Management - RCM

About this Position

We're looking for Athena Specialist who has worked on Athena Tool in AR follow up.

• Work directly with the insurance company, healthcare provider, and the patient to get a claim processed and paid.
• Verifying correct insurance filing information on behalf of the client and patient
• Verifying receipt of all patient registration data from the client and notifying the client of potential coding problems.
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Follow up on unpaid claims within the standard billing cycle time frame.
• Research and appeal denied claims.
• Meet individual and departmental standards with regard to quality and productivity.
• Ability to handle protected health information in a manner consistent with the Health Insurance Portability and Accountability (HIPAA).
• Check eligibility and benefit verification.
• Review patient bills for accuracy and completeness and obtain any missing information
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid.

Responsibilities and Duties
Able to perform eligibility verification, precertification, through the web or verbally with insurance companies.
Calling insurance companies and obtaining claim status with different payers & documenting it in the system.
Should be able to read superbills and make charge entry in PMS.
Ability to post ERA (Electronica Remittance Advice) & EOB (Explanation of Benefits) from various systems and websites.
Credentialing knowledge would be an added advantage
Denial management should be known.
Job Type: Full-time 
Location - Work from Office