Senior Rep-Denials-Revenue Cycle-Hybrid
HybridRochester, Minnesota, United States
Job Summary
Ensure payment integrity for Mayo Clinic services by interpreting claim processes, payer contracts, and industry standards. Resolve complex issues involving CPT, ICD-10, and modifier coding while maintaining accurate documentation in the patient accounting system. Interpret data to draw conclusions, review findings, and provide recommendations for process improvements. Assertively communicate with third-party payer representatives and coordinate with internal areas to ensure favorable patient outcomes. Adhere to quality assurance guidelines, productivity standards, and applicable state, federal, and local laws. Participate in special projects as directed by the Supervisor. This hybrid role requires on-site presence within 100 miles of Mayo Clinic campuses.
Required Qualifications
- Located within 100 miles of any of the Mayo Clinic campuses
- Deep understanding of revenue cycle and payer policies
- Ability to resolve complex issues
- Deep insight into claim processes
- Comprehensive interpretation and understanding of payer contracts and industry standards
- Comfortable with ambiguity
- Good decision making and judgment capabilities
- Attention to detail
- Self-motivated
- Self-directed
- Highly organized
- Agree to promote a productive, collegial workplace
- Ability to prioritize work and handle a variety of tasks simultaneously
- Belief in the mission
- Strong ethical conduct
- Assertive communication with third party payer representatives
- Effective communication and coordination with necessary internal areas
- Ability to take initiative to continuously learn within assigned job function
- Ability to interpret data, draw conclusions, review findings and provide recommendations for improvements
- Maintain a growing knowledge of applicable State, Federal and local laws/regulations
- Correct billing and coding requirements including industry specific data such as modifiers, CPT and ICD-10 coding
- Adherence to quality assurance guidelines
- Adherence to established productivity standards
- Consistently document within the patient accounting system all actions and encounters leveraging necessary standard codes
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.