Atrius Health, an innovative healthcare leader, delivers an effective system of connected care for more than 690,000 adult and pediatric patients at 30 medical practice locations in eastern Massachusetts. Atrius Health’s 645 physicians and primary care providers, along with 420 additional clinicians, work in close collaboration with hospital partners, community specialists and skilled nursing facilities. Our vision is to transform care to improve lives. Atrius Health provides high-quality, patient-centered, coordinated, cost effective care to every patient we serve. By establishing a solid foundation of shared decision making, understanding and trust with each of its patients, Atrius Health enhances their health and enriches their lives. Atrius Health is part of Optum, a health services company focused on building the leading value-based care system in the country.
SUMMARY
Under general direction provides analytical, denial, and AR management support. Gathers, compiles and organizes claims and denial data. Researches clinical and payer informational material for clinical and business initiatives, ongoing clinical and billing processes, and resolution of complex medical necessity and billing policy related to denied claims for all payers. In accordance with department policies and procedures responsible for responding to payer claim audits including Medicare program, writing complex clinical medical necessity appeals, analysis of claims data and billing related issues to effectively reduce errors and increase revenues. Generates and collates denied claim analysis, provides proactive denial interventions, analyzes and reviews claims for coding corrections and applies charge corrections for special projects. Works under supervision on routine but productive assignments.
EDUCATION/LICENSES/CERTIFICATIONS
- Bachelor’s degree (or equivalent education, training or experience) required.
- Certification in medical coding is preferred including CCS, CCS-P, CPC or other relevant certification thru AHIMA or AAPC.
EXPERIENCE
- Minimum of 3-5 years of experience in medical billing/denial management or claim data analysis required.
- Plus if candidate has specific experience in medical policy/chart reviews for claim coding corrections and writing medical necessity related appeals.
- Prior experience generating and interpreting data and reporting analysis and conclusions.
SKILLS
- Understanding and working knowledge of medical terminology and clinical concepts including information about diseases, therapies, drug treatments and interpretation of lab and imaging tests, billing rules.
- Knowledge of CPT and ICD10 codes required.
- Detailed oriented with strong analytical, communication and writing skills.
- Excellent organizational skills and the ability to perform, with accuracy, multiple tasks simultaneously is required.
- Must have strong computer skills, including proficiency in Microsoft Excel.
Atrius Health is committed to a policy of non-discrimination and equal employment opportunity. All patients, employees, applicants, and other constituents of Atrius Health will be treated with respect and dignity regardless of race, national origin, gender, age, religion, disability, veteran status, marital/domestic partner status, parental status, sexual orientation and gender identity and/or expression, or other dimensions of diversity.
Benefits Include:
· Up to 8% company retirement contribution,
· Generous Paid Time Off
· 10 paid holidays,
· Paid professional development,
· Generous health and welfare benefit package.
Atrius Health is an equal opportunity/affirmative action employer and does not discriminate in recruiting, hiring, training, promoting or any other employment practices on the basis of race, color, religion, sex, marital status, age, sexual orientation, gender identity, national origin, military service or application for military service, veteran or disability status.
Applicants have rights under Federal Employment Laws: Family and Medical Leave Act (FMLA);Equal Employment Opportunity (EEO); and Employee Polygraph Protection Act (EPPA).
VEVRAA Federal Contractor
Request Priority Protected Veteran & Disabled Referrals for all of our locations within the state
