Allowables Representative

Akron, OH
Permanent
Full-time

1 day ago
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TeamHealth is proud to be the leading physician practice in the U.S. providing exceptional patient care, together. TeamHealth has been recognized by Newsweek as one of America's Greatest Workplaces in Health Care for 2025 -Becker's Hospital Review names TeamHealth among the top 150 places to work in healthcare. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us!What we OfferCareer Growth OpportunitiesA Culture anchored in a strong sense of belongingBenefits (Medical/Dental/Vision) begin the first of the month following 30 days of employment401k (Discretionary match)Generous PTO8 Paid HolidaysEquipment Provided for Remote RolesJOB DESCRIPTION OVERVIEW:The Allowables Analyst will review, organize, and resolve invoices that have allowable variance denials, taking appropriate corrective action as directed by the Allowables Manager. The Analyst researches carrier denials as needed and processes payment disputes/appeals for assigned states and/or payers.ESSENTIAL DUTIES AND RESPONSIBILITIES:▪ Monitor and review invoices with allowable variance denials within assigned states/payers. Analyst performs research as needed, to include eligibility verification for FSC appropriateness, EOB review, posting accuracy review and processing subsequent payment disputes/appeals with the carrier via an appropriate method for the invoices involved.
▪ Generate and/or utilize variance reports (Daily, Weekly, Monthly, On-Demand) to identify carriers with allowable variance denials, reporting any noted trends to the Allowables Manager. Review the Underallowed Monthly Aging report and adjust priorities as necessary.
▪ Utilize the telephone and available carrier portals/websites for research, submission of payment disputes/appeals and otherwise expediting issue resolution.
▪ Review carrier Provider Manuals, portals and websites and inform management of any new carrier procedures/requirements as applicable.
▪ Monitor the progress of payment disputes/appeals
▪ Routinely review monthly Managed Care/Contract Management meeting minutes, noting trends and as a directive for assembly of monthly MC/CM meeting reports.
▪ Consult with Allowables Manager for unusual circumstances that may include system data issues, payer responses and MC/CM/PCM maintenance issues.
▪ Process carrier phone calls/correspondence regarding Contracted Payor Notification letters.
▪ Consistently meet established completion times for projects and assignments.
▪ Consistently meet/maintain QA (95% or better) and designated production standards.
▪ Perform additional duties as directed by the Allowables ManagerQUALIFICATIONS / EXPERIENCE:▪ Thorough knowledge of physician billing policies and procedures
▪ Thorough knowledge of healthcare reimbursement guidelines
▪ Computer literate, intermediate knowledge of Excel/Word preferred
▪ Ability to work independently in a fast-paced environment
▪ Excellent oral and written communication skills
▪ Good analytical and organizational skills
▪ Minimum high school diploma, or equivalent
▪ One to three years' experience in physician medical billing with emphasis on
research, contract review and claim denials
▪ General knowledge of ICD and CPT coding guidelinesSUPERVISORY RESPONSIBILITIES:▪ NonePHYSICAL / ENVIRONMENTAL DEMANDS:This position involves high production volume in a pleasant, fast-paced environment with
extensive computer use.
▪ Job is performed in a well-lighted, climate-controlled, modern office setting.
▪ Prolonged sitting at a workstation using a computer.
▪ Moderate phone use.
▪ Moderate bending and standing.
▪ Moderate stress level.
▪ Occasional lifting and carrying of up to 25 pounds.This position may require manual dexterity and/or frequent use of the computer, telephone,
10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform
repetitive motions and/or meet production standards to comply with the essential functions.Also, may require physical and/or mental stamina to work overtime, additional hours beyond
a regular schedule and/or more than five days per week.

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