Appeals Analyst - Full Time

Hughston Clinic • Columbus, GA

1d

About The Position

Utilize coding certification knowledge and experience to monitor contractual allowances; analyzing and pursuing appeal opportunities with payers and networks, and reporting appeals performance. Perform claim audits to ensure billing compliance with coding rules and guidelines as well as payer-specific policies. Analyzes revenue cycle processes in order to develop tools and guidelines for educational opportunities. Conducts research initiatives to support overall billing compliance.

Requirements

• Five years with insurance claims/related experience, CPT and ICD-10 terminology experience or Three years of above described experience with a Associates degree or higher in related field
• High school diploma or equivalent
• Up-to-date coding certification; either CPC or coding credentials via AHIMA.
• Knowledge and PC skills, with proficiency in utilizing Microsoft office products (Word, Excel, Outlook, PowerPoint, etc.)
• Knowledge of medical terminology.
• Demonstrated skill in written and oral communication with colleagues, supervisors, and payer/network personnel.
• Demonstrated skill working in a team-oriented structure to achieve goals.
• Must be able to work independently

Nice To Haves

• Associates degree or higher
• Experience conducting revenue cycle / billing related audits
• Knowledge of networks, IPAs, MSOs, HMOs, PCP and contract affiliations.
• Knowledge of the health care professional services billing (physicians and related health care professionals) and reimbursement environment.
• Knowledge of major types of practice management system (PMS) and EOB imaging systems.
• Knowledge of managed care contracts and compliance.
• Demonstrated skill in gathering and reporting claims information.

Responsibilities

• Implements process for identifying under-allowed claims using Experian Contract Manager and other available tools
• Reviews and analyzes EOBs for identified under-allowed claims
• Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member information for managed care plans
• Uses feedback and experience to refine communication skills and tools for use in preparing written and telephone appeals
• Batches appeals, when applicable, by payer or network, by CPT/HCPCS code combination, by error type, or by provider
• Compiles and submits appeals and monitors for proper reimbursement
• Uses Experian Contract Manager to track appeals and recoveries
• Establishes and cultivates helpful and effective contacts in payer or network offices
• Establishes follow-up protocol with payers and networks
• Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to the Director of Revenue Optimization Management
• Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts
• Cross-trains and performs appeals analysis within Hospital claims, as needed
• Maintains the strict confidentiality required for medical records and other data
• Participates in professional development efforts to ensure currency in managed care reimbursement trends

Benefits

• equal opportunity employer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED