Homeoffice Reimbursement Specialist presso VillageMD

About Our Company

We’re a physician-led, patient-centric network committed to simplifying health care and bringing a more connected kind of care.

Our primary, multispecialty, and urgent care providers serve millions of patients in traditional practices, patients' homes and virtually through VillageMD and our operating companies Village Medical, Village Medical at Home, Summit Health, CityMD, and Starling Physicians.

When you join our team, you become part of a compassionate community of people who work hard every day to make health care better for all. We are innovating value-based care and leveraging integrated applications, population insights and staffing expertise to ensure all patients have access to high-quality, connected care services that provide better outcomes at a reduced total cost of care.

Please Note: We will only contact candidates regarding your applications from one of the following domains: @summithealth.com, @citymd.net, @villagemd.com, @villagemedical.com, @westmedgroup.com, @starlingphysicians.com, or @bmctotalcare.com.

Job Description

Essential Job functions:

• Monitoring and working the workflow dashboard for assigned providers and specialties, to include researching and correcting claims on MGRHOLD, writing appeals and facilitating their submission by Athena for appealing adverse decisions, contacting payers and Medical Directors as needed, and all other activities that lead to the successful adjudication of eligible claims.

• Oversight of HOLD and monitoring of MISSING SLIPS for assigned providers and specialties.

• Any coding and charge entry based on assigned providers and specialties.

• Completing claims worklists assigned by Reimbursement Supervisor.

• Bi-monthly reporting of dashboard status to Reimbursement Supervisor via Excel spreadsheet or other template to include aged since last touch balances and error reasons.

• Run reports for distribution to the physician and physician staff as needed to communicate data of interest, work performed, or ad hoc.

• Complete system knowledge, ability to run reports, worklists, and research and resolve an assigned subset of unpostables, payment batches.

• Responsible for running the Zero Pay Worklists at a minimum of bi-weekly for assigned providers and specialties, reviewing and responding to adjustments with approval or appeal.

• Field Patient Accounts staff or practice-based patient balance due questions and complaints as well as insurance needs on behalf of assigned providers and specialties.

• Receive transferred calls or emails from Patient Accounts staff with patient's requesting advanced assistance with their account.

• Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws.

General Job functions:

• Expert in athenaCollector co-sourcing model.

• Expert in management and resolution of items in the MGRHOLD bucket:

• Expert in Oversight and Guidance/Management of HOLD bucket and Missing

• Tickets for assigned AR.

• Expert in EOBs and ERA and what they mean in athenaNet.

• Expert in Communication

• Claim notation

• Physician and Practice location staff

• Peers

• Supervisor/Manager

• Appeals and Payers

• Athena CSC and athenaNet

• Expert in sorting work queues and Worklists

• Zero Pay

• Fully Worked Receivables

• Claim Attachment Error Queue

• Payment Mismatch

• Unpostables worklists/dashboard research and resolution

• Unapplied Worklist

• Expert in generally accepted insurance benefit terms and processes Expert in Quickview, Registration, and Claim Edit screens. All screens, tools and data locations available under the user's security access.

• Expert in interpretation of billing slips for claim/code creation

• Facility-based charge entry

• Expert in request/preparation of supporting documentation such as medical records, dictation, appeal letters, contract pages.

• Expert in patient balance policies, workflows, and tools.

• Expert in management of TOS payment need(s)

• DAILY process of opening, closing and reconciling payment/deposits

• Expert in investigation and Denial/Appeal/Preparation of Refunds:

• Patient

• Insurance

Expert in reporting, Activity Wizard, AR Wizard, Report Builder and any available reports in Library or through other means in Athena:

• Expert in customer service to patients and Physicians/Staff.

• Familiar with Patient 5 Stage Workflow Concept.

• Familiar with Registration, Scheduling, Check In and Check Out, pre-view and

• Day End Review, and other procedures, processes, and tools both in SMG policy and athenaCollector.

Rules versus denials

• Kickcodes -- what they are and what they do

• Claim note history including actions and claim statuses

Travel:

• Travel to Satellite locations for meetings

• High School Graduate/GED required.

• Associate's or Bachelor's degree preferred.

• Experience with athenaCollector and Anodyne preferred.

• 3-5 years experience required.

This is a non-exempt position. The base hourly compensation range for this role is $21.50 to $25.25.  At VillageMD, compensation is based on several factors including, but not limited to education, work experience, certifications, location, etc.  The selected candidate will be eligible for a valuable company benefits plan, including health insurance, dental insurance, life insurance, and access to a 401k plan.

About Our Commitment

Total Rewards at VillageMD

Our team members are essential to our mission to reshape healthcare through the power of connection. VillageMD highly values the critical role that health and wellness play in the lives of our team members and their families.  Participation in VillageMD’s benefit platform includes Medical, Dental, Life, Disability, Vision, FSA coverages and a 401k savings plan.

Equal Opportunity Employer

Our Company provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to, and does not discriminate on the basis of, race, color, religion, creed, gender/sex, sexual orientation, gender identity and expression (including transgender status), national origin, ancestry, citizenship status, age, disability, genetic information, marital status, pregnancy, military status, veteran status, or any other characteristic protected by applicable federal, state, and local laws.

Safety Disclaimer

Our Company cares about the safety of our employees and applicants. Our Company does not use chat rooms for job searches or communications. Our Company will never request personal information via informal chat platforms or unsecure email. Our Company will never ask for money or an exchange of money, banking or other personal information prior to the in-person interview. Be aware of potential scams while job seeking. Interviews are conducted at select Our Company locations during regular business hours only. For information on job scams, visit, https://www.consumer.ftc.gov/JobScams or file a complaint at https://www.ftccomplaintassistant.gov/.