Administrative Assistant - Appeals

PAM Health Corporate Office•Enola, PA

About The Position

Responsible for maintaining Pending Appeals list in My Ability assigned to Clinical Appeals. Request appropriate medical records based on appeal type. Provide daily admission reports and appropriate medical records for RCD review and submission. Responsibility for timely review and routing of incoming correspondence related to denials and appeals. Performs other related duties as assigned or requested. At P AM Health , we care for chronically and critically ill patients who require extended hospital care. PAM Health has over 80 hospital locations and employs over 11,000 people across the country. Our teams work together to deliver the highest level of compassionate care ensuring the best possible outcome for our patients. What can we offer you as a full-time employee? Medical benefits: EPO/HDHP/HSA options, including prescription coverage, Rx ’n Go, and Teladoc Comprehensive dental and vision benefits Employee Assistance Program, including counseling, legal, and financial services Flexible spending (FSA) and health savings (HSA) accounts Life and Disability insurance benefits Education/In-Service Opportunities including continuing education and tuition assistance Supplemental benefits: Accident, critical illness, cancer, pet, and identity theft protection insurance options Auto, Home, Cell Phone, and Gym Membership discount offerings Personal Travel Discounts 401(k) plans and discretionary employer match Generous Paid Benefit Time

Requirements

High School diploma required; one to two years of college preferred, especially healthcare related.
6 months or more of hospital business/admissions office or insurance related experience.
Overall knowledge of business procedures.
General knowledge of third payors, collection laws, FTC rulings and collection procedures.
Experience with automated account systems.
Experience with insurance/medical terminology.
Operate personal computer, 10-key.
Excellent telephone and customer service skills.

Responsibilities

Review all appeals entered in Inovalon for Clinical Appeals and determine appeal type. Manually enter denials in My Ability as needed.
Ensure all documents required by the Clinical Team are uploaded into Inovalon based on appeal type. Request appropriate medical records based on initial review of appeal type.
Confirm all payer requirements for submission of appeals, i.e. Address, phone number, filing deadlines, applicable provider specific requirements.
Update patient accounts in Wellsky to note appeal received by Clinical Appeals and ensure that they are in the appropriate Account Follow Up Statuses.
Make digital working folder for each appeal, downloading documents and medical records upon receipt.
Review and respond to incoming Medical Records requests. Identify those needing analyst review prior to submission and notify HIM of this need. Document requests received on the appropriate tracking logs.
Review and route all incoming correspondence to appropriate Clinical Appeals Analyst/RCD Analyst
Pull and distribute Daily Admissions Reports for RCD Analysts.
Download and disseminate medical records to appropriate folders for RCD Analyst review.
Assist in maintaining various tracking logs as assigned.
Work collaboratively with Clinical Appeals Analysts/RCD Analysts on issues to identify solutions and improve processes.
Work collaboratively with team members and staff outside of the Clinical Appeals Team to resolve issues on accounts. Including but, not limited to Managed Care, Reimbursement, Finance, Clinical, Legal, Admissions, Facility Business Office Managers, IT, Case Management, HIM, Coding and Charging departments.
Maintains the highest level of customer service via courtesy, compassion and positive communication.
Promotes the mission and vision of PAM Health within the work environment and the community.
Respects dignity and confidentiality by adherence to all applicable policies and procedures.
Works in a manner that promotes safety; wears clothing appropriate to the performance of the job.
Participates in OSHA required training.
Follows universal precautions as appropriate for position; complies with Employee Health requirements for continued employment.
Reports unsafe practices to management.
Knows own role in case of an emergency.

Benefits

Medical benefits: EPO/HDHP/HSA options, including prescription coverage, Rx ’n Go, and Teladoc
Comprehensive dental and vision benefits
Employee Assistance Program, including counseling, legal, and financial services
Flexible spending (FSA) and health savings (HSA) accounts
Life and Disability insurance benefits
Education/In-Service Opportunities including continuing education and tuition assistance
Supplemental benefits: Accident, critical illness, cancer, pet, and identity theft protection insurance options
Auto, Home, Cell Phone, and Gym Membership discount offerings
Personal Travel Discounts
401(k) plans and discretionary employer match
Generous Paid Benefit Time