Appeals Specialist

RESEARCH DATA GROUP INC•Salem, VA

1d•$30 - $40•Onsite

About The Position

LOCAL CANDIDATES ONLY POSITION IS FULL TIME IN OFFICE Compliance Analysis and Appeal review Receives, investigates, and responds to appeals from hospitals. Research and obtain appropriate documentation to support the appeal. Review of UB04 and detailed itemized statements Review of automated system analysis Perform hospital coding analysis. e.g. Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes. Review procedure/facility codes for unbundling, MUE’s, multiple procedures, inpatient codes on outpatient bills, routine services, etc. Review of UB04 and detailed itemized statements Assist in Internal Code Creation Attend required staff training and meetings. Other special projects as needed. Medical Review and Pricing Analysis Review medical record documentation as relates to the UB04 and itemized statement Identify compliance and billing errors as well as make appropriate documentation as relates to review performed Obtain hospital CMS certification information

Requirements

Two-year experience in Microsoft Office and Excel programs
Proficient data entry skills and accuracy
Ability to follow procedures.
Comprehension of hospital coding, billing guidelines and regulations, to include but not limited to, Medicare guidelines, application of Health Insurance Policies, and current industry standards.
Exceptional attention to detail
Excellent organizational, analytical, and problem-solving skill
Capable of handling multiple projects in a fast-paced, hyper-growth environment
Strong interpersonal and team-building skills
1-2 years’ experience as LPN or RN preferred.
One or more years of experience working with healthcare claims that demonstrate expertise in ICD 9/10 Coding, HCPCS/CPT Coding, DRG and medical billing for an Insurance company and/or hospital.
One or more years of experience performing medical record reviews is required.
Medical Terminology
Problem-solving skills to research and resolve discrepancies, denials, appeals.

Nice To Haves

Certified Professional Coder (CPC), (CPMA) (preferred but not required)
Medicare Appeals processing background. (Preferred)
RAC Audit experience (Preferred but not required)
Knowledge of Medical fraud/abuse healthcare laws (Preferred but not required)
Rev cycle management (Preferred)

Responsibilities

Receives, investigates, and responds to appeals from hospitals.
Research and obtain appropriate documentation to support the appeal.
Review of UB04 and detailed itemized statements
Review of automated system analysis
Perform hospital coding analysis. e.g. Medically Unlikely Edits (MUEs), the Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT) and Diagnosis Codes.
Review procedure/facility codes for unbundling, MUE’s, multiple procedures, inpatient codes on outpatient bills, routine services, etc.
Assist in Internal Code Creation
Attend required staff training and meetings.
Other special projects as needed.
Review medical record documentation as relates to the UB04 and itemized statement
Identify compliance and billing errors as well as make appropriate documentation as relates to review performed
Obtain hospital CMS certification information