Rejections Specialist

Overview

The Rejections Specialist plays a critical role in managing collections and resolving complex billing issues related to insurance claims. This position focuses on addressing non-payable claims, following up with insurance payers for claim payments as per client agreements, and strictly adhering to all relevant billing regulations.

Key Duties

• Conduct follow-ups on rejected and denied insurance claims to secure appropriate reimbursements for clients.
• Timely process accounts receivable (AR) work lists assigned by management.
• Prepare appeal letters following established protocols aimed at resolving claim denials in a single contact whenever possible.
• Identify and correct claims that were denied, unpaid, or not adjudicated due to issues such as coverage discrepancies, medical record requests, or authorization needs.
• Advise on accounts that may require write-offs through adjustment requests.
• Report any changes in address or filing rules to management promptly.
• Verify for any missing payments in the system.
• Accurately document patient account details.
• Review all correspondence meticulously to determine issues related to claims.
• Investigate patient accounts thoroughly to ascertain follow-up actions such as adjustments, correspondence, or contacting insurers.
• Manage and pursue the appeal process for denied claims including filing appeals.
• Engage in inbound and outbound calls as necessary for account follow-ups.
• Address inquiries from insurance companies regarding claim status.
• Communicate effectively with insurers to track the progression of pending claims.
• Achieve the production and quality benchmarks set by Ventra Health.
• Utilize online portals to retrieve Explanation of Benefits (EOB) documents.
• Participate in special assignments and other tasks as assigned.

Qualifications

• Minimum education requirement is a High School Diploma or an equivalent qualification.
• At least two years of experience in posting insurance payments within a healthcare environment.
• Preferred two years’ experience interpreting insurance Explanation of Benefits (EOB) statements.
• Certifications such as AAHAM or HFMA are considered advantageous.
• Experience collaborating with offshore teams is desired.