Offer summary

Qualifications:

Minimum 3 years of experience in medical reimbursement and denial management., Ability to read and understand Explanation of Benefits (EOBs)., Proficiency in MS Excel, Word, and PDF formatting/editing tools., High school diploma or GED with some college coursework, and strong communication skills..

Key responsibilities:

Research and resolve claim denials within payor guidelines.

Identify trends causing underpayments or denials and escalate issues.

Handle appeals, claim status inquiries, and resolve unapplied payments.

Communicate effectively with payors and patients to facilitate claim resolution.

Job description

Corporate

At ZOLL, were passionate about improving patient outcomes and helping save lives.

We provide innovative technologies that make a meaningful difference in peoples lives. Our medical devices, software and related services are used worldwide to diagnose and treat patients suffering from serious cardiopulmonary and respiratory conditions.

ZOLL Data Systems, a division of ZOLL Medical Corporation, is a healthcare software solutions provider that empowers hospital, EMS and Fire, and billingaccounts receivable (AR) teams to deliver more—from better patient outcomes to operational efficiencies and greater revenue capture. Our business exists to help save more lives through datadriven innovation and interoperability, opening new pathways for our customers to achieve the highest levels of care, collaboration, and reimbursement.

Job Summary

This position is responsible to resolve aged accounts and must have denial management experience in multiple states and sometimes internationally. Must have Revenue Cycle Management experience. Professional communication skills are required for interaction with colleagues, payors and management.

Essential Functions

Experience working in the ambulance transportation field preferred.

Denial Management – Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
Trend Identification – Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
Payor Escalation – Ability to understand and navigate payor guidelines. Determine and escalate claim issues with payor when appropriate.
Trend Escalation – Meet with leadership to discussresolve reimbursement andor payor obstacles.
Appeals – Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier. Take appropriate action to resolve claim.
Claim Status – Use available resources such as payor portals and clearinghouses to review unresolved accounts.
Unapplied Payments – Identify unapplied payments and take appropriate action to resolve account.
Phone Calls Call appropriate payors or patient to obtain the information necessary to resolve the claim.
Medical Record Requests – Obtain necessary information from appropriate source(s) to obtain payment from payors. This includes obtaining records from treating facilities.
Medical Insurance Policies Knowledge and understanding of current policies and procedures required to determine claim resolution.
Overpayment Resolution – Process or appeal refund requests following federal, state andor payor guidelines.
LegalSubrogation Requests – Knowledge of HIPAA and multiple state guidelines to process attorney requests.
Coordination of Benefits – Ability to review eligibility response and determine payor sequence. Knowledge of Medicare Part A vs Part B benefits and liability guidelines.
Patient Inquiries Respond to written and verbal inquiries from patients regarding their account. Process charity and payment plan following established policy.
Communication – Clear and concise communication both written and verbal, including documenting all activities associated with an account.
Production and Quality Standards – Must meet company standards and ability to work in fast paced environment.