Translational Pulmonary and Immunology Research Center and SoCal Food Allergy Institute (SCFAI) are unique biomedical research and software organizations that utilizes technology and data to drive patient care and business decisions.
We are a small dynamic team driving research breakthroughs that push the boundaries of what is possible in the treatment of rare diseases and food allergies. This position will track the status of our accounts receivable and follow up on denied or outstanding claims. The position requires contacting insurers and patients by phone and email to pursue claims payments.
Duties/Responsibilities:
- Daily follow-up on open and denied claims, filling of claims and appeals, and general collections of outstanding accounts.
- Research and work accounts to completion (zero balance).
- Make reasonable decisions on accounts (appeal, transfer responsibility, coder review, supervisor review, adjust, re-bill, or phone call).
- Have accountability on accounts placed on HOLD or Re-assigned.
- Complete assigned daily/weekly work queues. Meet or exceed daily productivity goals.
- Enter legible notes and read all prior notes before taking action.
- Answer incoming calls, provide professional customer service at all times. Assist patients as best as you can by going above and beyond, even if it means calling the insurer on their behalf.
- Identify system issues and bring to management’s attention with possible solutions and/or suggestions.
- Contribute to team goals and work on special projects.
- Create Financial Snapshots for the Enrollment Team
- Cross train to help complete tasks that the Pre-Authorization Specialist works on
Required Skills/Abilities:
- Strong and proven track record of successfully managing customer relationships and technical projects.
- Excellent work ethic and leadership skills.
- Self-motivated, team-oriented, very responsible, and focused on exceeding customer expectations.
- Exceptional organizational, presentation, and communication skills, both verbal and written.
- Insurance Policy Knowledge
- Knowledge of EOB (Explanation of Benefits)
Education/Experience:
- High School diploma or GED
- 2+ years of experience in medical billing and collections
- Basic understanding of healthcare claims
- Knowledge of ICD-9, HCPCS and CPT coding
Physical Requirements:
- Prolonged periods of sitting at a desk and working on a computer.
- Must be able to lift up to 20 pounds.
TPIRC provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, marital status, veteran status, or any other consideration made unlawful by federal, state, or local laws. TPIRC is committed to providing reasonable accommodation for qualified applicants, and employees with disabilities to ensure they enjoy equal access to all employment opportunities and benefits of employment as required by the Americans with Disabilities Act. TPIRC is an Equal Opportunity Employer and participant in the U.S. Federal E-Verify program.