Account Assistant 4 - Coding Denials
Yale University, New Haven, CT, United States
Under the direction and supervision of the Associate Director and Team Lead/Manager, you will be responsible for insurance follow‑up on carrier denials with a focus on coding denials for Yale Medicine.
You will act as a liaison in the day‑to‑day follow‑up of denied and no‑response claims to obtain maximum reimbursement for services rendered by Yale Medicine and other related practices.
Your duties will include following up of denied and appealed claims for Yale Medicine and its related specialties, following up on provider ineligible denials per Epic rejection codes, and processing carrier denials to ensure compliance with payer Explanation of Benefits.
You will write, send, and follow up on appeals, research carrier policies, review medical documentation, and work collaboratively with Yale Medicine staff to secure maximum reimbursement.
Direct communication will occur with third‑party insurance carriers, patients, and other listed payers to investigate payment delays for both primary and secondary claims.
You will respond to requests from carriers, Yale Medicine clinical departments, and patients for supporting documentation, work closely with centralized and non‑centralized Business Office units to resolve outstanding claim, billing, or payer issues, and identify carrier/specialty issues that aid in claim processing and resolution.
Additionally, you will be responsible for reviewing and validating charge reviews and claim edits to ensure accurate coding in compliance with Yale Medicine guidelines, and you will interact with all Yale Medicine departments to resolve coding, fee, and documentation matters to expedite claim processing.
Principal Responsibilities
Serve as a principal source of information on rules and procedures governing University accounts receivable.
Oversee and instruct support staff.
Maintain account files, ensuring accuracy and completeness.
Review payment histories.
Resolve problem and delinquent accounts with supervisor and collection agency.
Assist with final review and disposition of problem accounts.
Recommend and implement changes to systems and operating procedures.
Compose form letters and correspondence used in accounts receivable activities.
Research individual accounts, summarize findings in reports, and perform clerical functions incidental to account activity.
Process forms and compete on account activity.
Skills & Abilities
Knowledge and working experience with CPT, ICD‑10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUEs).
Working knowledge and experience with Microsoft Office, especially Excel and Word.
Experience with EPIC and EPIC work queues.
PC data entry experience.
Ability to work independently and as part of a team.
Ability to multi‑task in a high‑volume environment.
Strong verbal and written communication skills.
Excellent attendance and reliability.
High energy and motivation, ability to work under pressure and handle a high volume of accounts.
Required Education and Experience Four years of related work experience, two of them at the next lower level in the same job family, and high school education; or two years of related work experience and an Associate’s degree; or an equivalent combination of experience and education.
Background Check Requirements All candidates will be subject to a pre‑employment background screening, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position requirements. All offers are contingent upon successful completion of the background check.
Health Requirements Certain positions have associated health requirements based on specific job responsibilities, which may include vaccinations, tests, or examinations required by law, regulation, or university policy.
Equal Employment Opportunity Yale is committed to judging admissions, education, and employment based on qualifications and abilities. In accordance with federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era, or other covered veteran.
Policy Yale University is a tobacco‑free campus.
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You will act as a liaison in the day‑to‑day follow‑up of denied and no‑response claims to obtain maximum reimbursement for services rendered by Yale Medicine and other related practices.
Your duties will include following up of denied and appealed claims for Yale Medicine and its related specialties, following up on provider ineligible denials per Epic rejection codes, and processing carrier denials to ensure compliance with payer Explanation of Benefits.
You will write, send, and follow up on appeals, research carrier policies, review medical documentation, and work collaboratively with Yale Medicine staff to secure maximum reimbursement.
Direct communication will occur with third‑party insurance carriers, patients, and other listed payers to investigate payment delays for both primary and secondary claims.
You will respond to requests from carriers, Yale Medicine clinical departments, and patients for supporting documentation, work closely with centralized and non‑centralized Business Office units to resolve outstanding claim, billing, or payer issues, and identify carrier/specialty issues that aid in claim processing and resolution.
Additionally, you will be responsible for reviewing and validating charge reviews and claim edits to ensure accurate coding in compliance with Yale Medicine guidelines, and you will interact with all Yale Medicine departments to resolve coding, fee, and documentation matters to expedite claim processing.
Principal Responsibilities
Serve as a principal source of information on rules and procedures governing University accounts receivable.
Oversee and instruct support staff.
Maintain account files, ensuring accuracy and completeness.
Review payment histories.
Resolve problem and delinquent accounts with supervisor and collection agency.
Assist with final review and disposition of problem accounts.
Recommend and implement changes to systems and operating procedures.
Compose form letters and correspondence used in accounts receivable activities.
Research individual accounts, summarize findings in reports, and perform clerical functions incidental to account activity.
Process forms and compete on account activity.
Skills & Abilities
Knowledge and working experience with CPT, ICD‑10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUEs).
Working knowledge and experience with Microsoft Office, especially Excel and Word.
Experience with EPIC and EPIC work queues.
PC data entry experience.
Ability to work independently and as part of a team.
Ability to multi‑task in a high‑volume environment.
Strong verbal and written communication skills.
Excellent attendance and reliability.
High energy and motivation, ability to work under pressure and handle a high volume of accounts.
Required Education and Experience Four years of related work experience, two of them at the next lower level in the same job family, and high school education; or two years of related work experience and an Associate’s degree; or an equivalent combination of experience and education.
Background Check Requirements All candidates will be subject to a pre‑employment background screening, which may include motor vehicle, DOT certification, drug testing and credit checks based on the position requirements. All offers are contingent upon successful completion of the background check.
Health Requirements Certain positions have associated health requirements based on specific job responsibilities, which may include vaccinations, tests, or examinations required by law, regulation, or university policy.
Equal Employment Opportunity Yale is committed to judging admissions, education, and employment based on qualifications and abilities. In accordance with federal and Connecticut law, Yale does not discriminate in admissions, educational programs, or employment against any individual on account of sex, sexual orientation, gender identity or expression, race, color, national or ethnic origin, religion, age, disability, status as a special disabled veteran, veteran of the Vietnam era, or other covered veteran.
Policy Yale University is a tobacco‑free campus.
#J-18808-Ljbffr