Healthcare Follow Up - Physician's Office

Healthcare Follow Up - Physician's Office

Cognizant is one of the world's leading professional services companies, we help our clients modernize technology, reinvent processes, and transform experiences, so they can stay ahead in our constantly evolving world. Do you thrive in a busy environment and are you able to multi-task successfully? If so, please apply today!

In this role, the successful candidate performs advanced level work related to resolution of physician claim denials. This position will be responsible for root cause analysis physician payer denials, experience in identifying procedures impacted by National Correct Coding Initiative Edits (NCCI), technical payer policies, appeal documentation and resolution. In addition, this position will be responsible for identification, collaboration, and implementation of process initiatives to reduce denials

Job Description:

• Resolution of Claim Denials: Perform advanced work related to resolving physician claim denials.
• Root Cause Analysis: Identify the root causes of physician payer denials and implement solutions.
• NCCI Edits: Understand procedures impacted by National Correct Coding Initiative Edits (NCCI).
• Appeal Documentation: Prepare and submit appeal documentation to resolve denials.
• Process Improvement: Collaborate on and implement initiatives to reduce denials.

Key Responsibilities:

• Problem Solving: Use exceptional problem-solving and critical thinking skills to resolve accounts and meet quality and productivity standards.
• Billing Guidelines: Demonstrate knowledge of state/federal billing guidelines, reimbursement methodologies, and payer policies.
• Recommendations: Suggest additions, revisions, or deletions to work queues and claim edits to improve efficiency.
• Pattern Identification: Identify patterns in denials and escalate to management with sufficient information for follow-up.
• Excel Skills: Use Excel to summarize and provide detailed reporting to management and clients.
• Tracking and Trending: Track and trend claim denials and underpayments to identify improvement initiatives.
• Communication: Ensure all actions are documented, appeal letters are effective, and root causes are communicated clearly.

Preferred Qualifications:

• Experience: 2-3 years in healthcare revenue cycle.
• Education: HS Diploma. Associate or bachelor's degree preferred.
• Technical Skills: Proficiency in Excel, payer portals, and claims clearinghouses.

Additional Duties:

• Examine Claims: Analyze denied and underpaid claims to determine discrepancies.
• Follow-Up: Communicate with payers to resolve outstanding claims and ensure timely reimbursement.
• Regulatory Compliance: Maintain a thorough understanding of federal and state regulations and payer-specific requirements.
• Documentation: Accurately document all activities and communications.
• Initiative and Resourcefulness: Make recommendations and communicate trends and issues to management.
• Problem Solving: Demonstrate strong problem-solving and critical thinking skills to resolve accounts and meet standards.

This role requires a combination of technical skills, industry knowledge, and strong problem-solving abilities

Salary and Other Compensation:

The hourly rate for this position is between $19.00 - 21.00 per hour, depending on experience and other qualifications of the successful candidate.

This position is also eligible for Cognizant's discretionary annual incentive program, based on performance and subject to the terms of Cognizant's applicable plans.

Benefits: Cognizant offers the following benefits for this position, subject to applicable eligibility requirements:

• Medical/Dental/Vision/Life Insurance
• Paid holidays plus Paid Time Off
• 401(k) plan and contributions
• Long-term/Short-term Disability
• Paid Parental Leave
• Employee Stock Purchase Plan

Disclaimer: The hourly rate, other compensation, and benefits information is accurate as of the date of this posting. Cognizant reserves the right to modify this information at any time, subject to applicable law.