Director, Medical Collections & Appeals

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