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Managed Care Follow Up Specialist at Elevate Patient Financial Solutions®

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

Associate degree in related field, 2 years in medical collections, Basic understanding of Revenue Cycle Process, Experience with payor online portals, Proficient in Microsoft Applications.

Key responsabilities:

Monitor and track status of appeals
Review hospital reconsiderations and appeals
Call payors to confirm appeal status
Manage claims resolution workflows
Document case processing and ensure compliance

Elevate Patient Financial Solutions® Large https://www.elevatepfs.com/

1001 - 5000 Employees

See more Elevate Patient Financial Solutions® offers

Job description

Elevate Patient Financial Solutions has an exciting career opportunity available as a Managed Care Follow Up Specialist.

This position will be a remote-based role.

The full time schedule for the position will be 8am-5pm, Monday-Friday with some flexibility.

Job Summary:

The Managed Care Appeals Follow Up Specialist will monitor and track the status of submitted reconsiderations, appeals, and disputes by ensuring timely follow-up and accurate resolution. The Appeals Follow Up Specialist will conduct research and coordination needed to evaluate, process, respond to, and refer or close appeals. This position will operate within healthcare, insurance, or related fields, and must understand policies, regulations, and specific circumstances surrounding each case.

Essential Duties and Responsibilities:

Review outstanding hospital reconsideration, redeterminations, and appeals for potential resolution within policy guidelines.
Ability to maintain high-volume caseload and adhering to the timeliness standard of the Appeals while conducting the due process review. Call payors to confirm appeal status: received, not on file, upheld, or overturned. Confirm appeal addresses, fax numbers, or payor portal information and timely appeal guidelines.
Manage applicable claims resolution workflows: 2nd level appeal, write off’s due to exhausted appeal levels or untimely appeals, resubmitting appeals not received, and monitoring appeals for payment.
Assist in the achievement of high performing and positive work environment that will promote the mission of ElevatePFS Payment Recovery Services.
Enhance professional growth and development through bridge online learning, and weekly team meetings.
Demonstrate attention to detail in researching appeal cases and documenting notes for proper case processing.
Complies with client, departmental, and organizational policies and procedures as they relate to the job.
Refers complex or sensitive issues to the attention of the supervisor to ensure corrective measures are taken in a timely fashion.
Accepts and learns new tasks as required and demonstrates a willingness to work where business needs are largest.
Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices.
Be cross trained in multiple clients and hospital system platforms.
Communicate in a professional with fellow coworkers, clinical staff, coders, supervisors, and representatives from payor organizations
Follow departmental guidelines for lunch, breaks, requesting time off, and shift assignments.
Regular and timely attendance.
Perform other duties as assigned.

Qualifications and Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

Graduation from an accredited college or university with an Associate degree in Business Administration, Healthcare Administration, or closely related field and 2 years of relevant work experience.
Minimum of two (2) years in medical collections.
A basic understanding of the Revenue Cycle Process.
Experience with payor online portals.
Organized and detail oriented.
Basic Microsoft Applications knowledge: Outlook, Excel, Word.

Benefits:

ElevatePFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.

Medical, Dental & Vision Insurance
401K (100% match for the first 3% & 50% match for the next 2%)
15 days of PTO
7 paid Holidays
2 Floating holidays
1 Elevate Day (floating holiday)
Pet Insurance
Employee referral bonus program
Teamwork: We believe in teamwork and having fun together
Career Growth: Gain great experience to promote to higher roles

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Elevate, PFS is an Equal Opportunity Employer