Claims A/R Follow-up Specialist

Allied Digestive Health is one of the largest integrated networks of gastroenterology care centers in the nation with over 200 providers and 60 locations throughout New Jersey and New York. As a fast-growing physician-led organization, our dynamic structure encourages physician input and decision-making, while simultaneously offering operational support. Our dedicated, compassionate team of providers prioritize personalized treatment plans for patients that deliver the highest quality of care. All of our doctors are board-certified in gastroenterology and hepatology. Several of them serve as chief of gastroenterology at nearby hospitals, and a number of them have been recognized as top-quality physicians in publications, including but not limited to: Best Doctors in America and Top Doctors New Jersey, and US News Health - US News & World Report.

We are excited to announce that we are looking for a Full-Time Claims A/R Follow-up Specialist at our Corporate office in West long Branch.

• Under the direction of the Accounts Receivable Manager, the Claims A/R Follow-up Specialists will Master Claim Denials and Claims Processing to contribute to claims denial prevention strategies and adjudicate the claim to pay.
• This role will also act as a subject matter expert for Denied Claim Escalations from vendors and colleagues.
• Review all coding denials for possible resubmission.
• This role will also work on high-level a/r projects assigned.
• He/she will be expected to adhere to quality and quantity standards of the practice as well as industry-mandated guidelines and regulations.
• Follows up on escalated claims or project claims no fewer than sixty-five (65-70) claims per day.
• Identifies trends and communicates them to AR management and senior leadership.
• Engage in the follow-up with Medicare and Commercial insurance claims.
• Conducts coding, billing, and documentation compliance audits within the established timeframe.
• Assist in identifying the need for new payer policy development/changes to meet regulatory requirements to ensure payment of claims.
• Prepares a report of findings and recommendations for improvement for each audit.

Must have the following qualifications and experience:

• Must possess CRC, or CCS-P
• Must have 5+ years' experience in
• The AR Coordinator must be well-versed in everything about Medicare
• Relevant experience in a professional audit capacity is required.
• Preferred strong technical knowledge of Institute of Internal Auditing (IIA) standards and Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding
• Proficiency in MS Office products - intermediate to advanced knowledge of MS Excel.

We offer a competitive base salary, generous benefits, including: Medical, Dental, Vision, Life Insurance, Voluntary, Time-Off Benefits, EAP, 401K and Commuter Benefits.

Job Type: Full-time