Medical Claims Review Manager jobs in South Bend, IN

WHO WE ARE:

AC3 was founded by practicing oncologists along with data and practice analytics experts to support the business side of medicine. Our mission is to modernize and digitize the delivery of healthcare and improve countless lives along the way.

We combine the power of big data technology and people to enable easier frontline decisions about complex problems. AC3 offers its employees an exciting, fast-paced, and challenging work environment. To learn more about AC3, visit us at www.ac3health.com.

COMPANY MISSION: To simplify healthcare and reduce the cost of care, empowering care givers to focus on what matters most – fighting cancer.

POSITION SUMMARY

This is a hybrid position; meaning, there are occasional onsite requirements. The ideal candidate will reside within a 2 - 3 hour radius of the office in South Bend, IN. This position is responsible for gathering and processing the information required to complete the medical insurance claims process. They will be responsible for documenting and entering required information in our systems. The team member is also responsible for ensuring the collection of outstanding accounts from insurance carriers, monitoring claims submission, writing letters of appeal, reviewing, and obtaining necessary documentation to submit claims. He/she will notify the Team Leader and Revenue Cycle Manger of any claim submission errors or specific payer issues to ensure the department.

ESSENTIAL FUNCTIONS AND JOB RESPONSIBILITIES

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Monitors delinquent accounts and assists in resolving issues to obtain payment.
• Compiles letters of appeal complete with LCD/NCD/ payer requirement citations.
• Knowledge of HCPCS codes and track payer policy changes to communicate with team.
• Interprets and utilizes medical policies and procedures.
• Maintains login credentials and access to all assigned payer portals.
• Monitors and works assigned tasks in PM system to maintain productivity metrics.
• Responds to all correspondence to clients and RCM team timely.
• Disputes and works all necessary zero pays, underpayments, and denials.
• Prevents all possible “timely follow-up” denials on claims or appeals.
• Determines covered medical insurance losses and overpayments.
• Documents all medical claims actions and resolutions as specified in SOP.
• Analyzes insurance claims to prevent fraud.
• Maintains the practices and principles set forth by AC3 leadership with a strong commitment to service, excellence, and quality.
• Maintains professional behavior, confidentiality, and discretion at all times, along with the ability to work with all levels of staff with a confident and professional demeanor.
• Follows HIPPA rules and regulations.

POSITION REQUIREMENTS

• High school diploma or equivalent (GED).
• Medical office experience/medical terminology preferred.
• Accurately maintains and adheres to all safety rules and regulations.
• Must be detail oriented and have problem solving abilities.
• Proficient in Microsoft Office preferred.
• Working knowledge/experience in electronic medical records and/ or other medical software if applicable.
• Must possess the ability to work with patients and family members in a confident, respectful, and socially professional manner.
• Must rely on experience and judgment to plan and accomplish goals.
• Excellent communication and organizational skills with the ability to work in a fast paced environment; prioritize tasks and workloads.
• Performs other duties as assigned.
• This is a remote position with the expectation of travel to meet the needs of the position. Work is completed in a general office environment, sedentary in nature but may require standing and walking for up to 10% of the time. The work environment is favorable with adequate lighting and temperature, and no hazardous or unpleasant conditions caused by noise, dust, etc. Must be able to operate standard office equipment and keyboards.

Why Work at AC3?

When you become an AC3 Team member, you can expect ongoing training, support, and a work culture like no other. We offer our Full-Time Team Members medical, dental and vision health and wellness benefits, along with employer paid life insurance, long and short-term disability policies. Because our team’s health and wellness are our priority, we start new hires off with an above average paid time out plan and offer a comprehensive wellness program, including onsite biometrics and ongoing mental and physical wellness support. We also provide all Team Members with access to company sponsored financial wellness counselors, employee assistance services and the opportunity to enroll in our company-matched, 401k plan.

Come join our Winning Team!