PFS Complex Claims Specialist

Iberia Medical Center (IMC) in New Iberia, LA is looking for team members who will help advance our vision to be the premier hospital of choice for patients, physicians and employees. We've been caring for our community for over 60 years and offer many diverse career paths. Our new employees experience opportunities to learn and grow while caring for their families, friends and neighbors.  

IMC is currently looking for a PFS Complex Claims Specialist , who ensures Ensures all assigned complex Commercial, Workers’ Compensation, VA, Blue Cross, Medicare Advantage, Medicaid, and specialty claims are researched, resolved, appealed, and collected in a timely and accurate manner. Handles complex insurance denials, appeals, payment disputes, refund requests, and overpayment investigations to ensure appropriate reimbursement and timely resolution of outstanding accounts. Monitors assigned billing reports, researches payer policy changes, identifies denial trends, and communicates findings to leadership to improve billing accuracy, reduce denials, and enhance revenue cycle performance.

SCHEDULE

• Full-Time
• Monday through Friday 8:00am- 4:30pm

 JOB RELATIONSHIP

•  WORKERS SUPERVISED: None
•  SUPERVISED BY:  PFS Assistant Manager

 QUALIFICATIONS:

• Education:   High school graduate or equivalent.
• Licensure/Certification:  N/A.
• Training and Experience:  Minimum 5 years prior medical billing and insurance collections experience, specific to hospitals. 

PRINCIPLE TASKS, DUTIES, AND RESPONSIBILITIES:

• Assistscurrentbillerswithcomplexdenials,billingissues,andspecialprojectsasneeded.

• ServesasprimarybackupforCommercial,Workers’Compensation,VA,BlueCross,MedicareAdvantage,SNF,Hospice,CopayAssistance,andMedicaidbillingandfollow-up.

• Preparesandfilesassigned121claims.

• Handlesthepreparation,billing,andfilingofallinpatientandoutpatientpsychiatricclaimsandotherspecialtyaccountsasassigned.

• Handleshigh-leveldisputes,appeals,andescalationsforaccounts120daysorolderfromdischargedate.

• Researchesandreviewspayerrefundandoverpaymentrequeststodetermineappropriateapprovalordispute.

• Researchespayerpolicychangesresultingindenialsandreportsfindingstomanagement.

• CommunicatesdenialtrendsandidentifiesopportunitiesforprocessimprovementtothePFSSupervisorandPFSLead.

• Worksdailybillingreports,includingLateCharge,SecondaryBilling,Exceptions,Unchecked,and24/72-HourReports.

• Ensuresassigneddenials,refilerequests,andotherinsurancecorrespondenceareaddressedwithin3–5businessdays.

• Performsadditionaldutiesandresponsibilitiesasassignedbythesupervisor.