Pathnostics is a diagnostic solutions company based in Irvine, CA, specializing in cutting-edge diagnostic services to help physicians resolve diagnostic and therapeutic dilemmas. The Medical Appeals and Collections Director is responsible for developing and managing the appeals resolution process in order to increase revenue and minimize denials.

This role focuses primarily on appealing denials, obtaining the status of submitted appeals, Quality Assurance, and gathering and reporting insights and best practices to make improvements. This role will collaborate with Payer Relations on managing and responding to Payer Audits. Additionally, this role has oversight of claim prior authorization, appeals, and collections team processes.

Primary Responsibilities:

Developing Appeals strategy and processes
Managing Appeals and Collections teams
Investigating & resolving claim denials
Initiate and resolve appeals for various payers
Managing claims collections, provide customer service to resolve issues
Communicating internally and with external customers to ensure timely review/resolution
Identifying trends and/or root cause of issues, and proposing solutions
Provide guidance and training to other collections team members
Resolve insurance discrepancies and short payments
Creation and management of spreadsheets to track key performance metrics
Create and/or revise Standard Operating Procedures for the Collections & Appeals team
Collaborate with Payer Relations on responding to payer audits
Other duties as assigned by management

Educational and work experience requirements

Bachelor’s degree or equivalent experience is preferred
5+ years of Medical Appeals and Collections experience ideally in laboratory proprietary testing environment
Management experience
Clinical experience is preferred (ability to perform clinical chart review/abstract information efficiently) but not required

Essential Skills/Abilities

Excellent written, interpersonal communication & negotiation skills
Excellent Excel, Access skills
Python data development or similar

NOTE: The ideal candidate for this role can report to our Irvine office daily for work, however, we will consider remote candidates with exceptional experience and qualifications for the role.

Pathnostics is proud to be an equal opportunity employer.

Job Type: Full-time

Benefits:

401(k)
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Life insurance
Paid time off
Vision insurance
Work from home

Schedule:

Monday to Friday

Ability to commute/relocate:

Irvine, CA 92614: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

Medical Appeals: 4 years (Required)
Medical collection: 4 years (Required)

Work Location: Hybrid

Job Type: Full-time

Pay: $140,000.00 - $145,000.00 per year

Pathnostics

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Director, Medical Collections & Appeals