Appeals Analyst - PFS CCD Revenue Integrity - Sharp Corporate - Day Shift - Full Time

Sharp HealthCare•San Diego, CA

8d•Onsite

About The Position

To appeal for underpayments compared to contract rates. Escalate payer contractual issues to payers and management of Sharp. Financial analysis and reporting Successfully file appeals/PDR's on non-clinical underpaid/denied claims and maintain standardized letters for use in training of account analysts. Required to explain new legislation impacting underpayments/denials etc. Trend and identify underpayment/denial issues for training purposes with the goal of mitigating future underpayments/denials. Work on ad hoc reports to reconcile inventory or identify opportunities for increased revenue collection using reporting tools. Assure the current quarterly, monthly, yearly insurance rates are obtained and loaded into the Contract Underpayment tool for accurate expected rate analyzation. Productivity Focus appeal efforts on underpayments/denials with highest propensity for recovery, considering Payor appeal timeframes, Payor contract reimbursement, underpaid/denial reason, facility, patient type. Regularly meet projected collection goals and appeal productivity standards. Maintains excellent communication with supervisor/management and high accuracy of work. Quality Using underpayment tool and billing software, review payor EOB, contract, payor website, etc. necessary to support basis for appeal. Must be cross-trained and file appeals outside assigned payor mix in the absence of fellow team member. Commence direct follow up action on appeals filed according to time frames. System integration Provide ongoing training/feedback to account analysts to improve success rate on initial appeals/PDR's filed. Participate in meetings with Management, to review and consult on appeal denial trends to determine next step/action plan towards resolution. Other duties, as assigned.

Requirements

H.S. Diploma or Equivalent
5 Years experience in all areas of billing
4 years accounts management experience in a multi specialty medical group.
Must possess strong analytical and mathematical skills to resolve underpayment inventory.
Must be detail oriented and possess a diligent work ethic.
Strong communication and excellent interpersonal skills.
Team Player.
Knowledge of benefits, covered services, Managed Care (contract payor) reimbursement and billing procedures of both government and non-government insurance programs.
Familiarity with current regulations of affiliated payors.
Familiarity with MS excel required.
Knowledge of ICD-9 and CPT-4 codes, and basic medical terminology.

Nice To Haves

Bachelor's Degree with emphasis in finance, business administration or economics.
Experience in resolving difficult underpayment/denial issues, categorizing inventory into underpayment reasons, identifying root cause, recognizing trends and clearly and persuasively articulating issues to payor.

Responsibilities

To appeal for underpayments compared to contract rates.
Escalate payer contractual issues to payers and management of Sharp.
Successfully file appeals/PDR's on non-clinical underpaid/denied claims and maintain standardized letters for use in training of account analysts.
Explain new legislation impacting underpayments/denials etc.
Trend and identify underpayment/denial issues for training purposes with the goal of mitigating future underpayments/denials.
Work on ad hoc reports to reconcile inventory or identify opportunities for increased revenue collection using reporting tools.
Assure the current quarterly, monthly, yearly insurance rates are obtained and loaded into the Contract Underpayment tool for accurate expected rate analyzation.
Focus appeal efforts on underpayments/denials with highest propensity for recovery, considering Payor appeal timeframes, Payor contract reimbursement, underpaid/denial reason, facility, patient type.
Regularly meet projected collection goals and appeal productivity standards.
Maintains excellent communication with supervisor/management and high accuracy of work.
Using underpayment tool and billing software, review payor EOB, contract, payor website, etc. necessary to support basis for appeal.
Must be cross-trained and file appeals outside assigned payor mix in the absence of fellow team member.
Commence direct follow up action on appeals filed according to time frames.
Provide ongoing training/feedback to account analysts to improve success rate on initial appeals/PDR's filed.
Participate in meetings with Management, to review and consult on appeal denial trends to determine next step/action plan towards resolution.
Other duties, as assigned.