Appeal Support Associate

Children's Healthcare of Atlanta•Brookhaven, GA

4d•Onsite

About The Position

Appeals third-party denials, trends payor and coding issues to maximize collections, and identifies root cause of payment denial sources to specific revenue cycle or clinical processes (e.g., patient accounting/follow-up, utilization review/case management, coding, medical necessity). Collects information on each case, summarizes clinical issues, and ensures that it is processed and followed to final resolution in a timely manner.

Requirements

3 years of experience in billing/collections/reimbursement in a hospital healthcare setting
2 years of experience in utilization review and/or case management in a hospital or insurance-related setting
Demonstrated excellent written communication skills

Nice To Haves

Licensed Practical Nurse (LPN) or Certified Professional Coder (CPC)

Responsibilities

Appeals third-party administrative and clinical denials to achieve expected reimbursement following payor requirements.
Provides clinical information to insurance companies as needed for completion of certification processes.
Ensures needed clinical information is documented into all billing systems.
Drafts appeal letters to insurance carriers based on both clinical and administrative information on accounts.
Performs timely follow-up on denials and tracks outcomes.
Maintains effective communication strategies so that collaboration and teamwork are enhanced throughout department and Children’s Healthcare of Atlanta.
Stays current with payor regulations and appeals processes.
Maintains professional development.
Works collaboratively with Utilization Review and Central Access Authorization teams and other departments.