CBO Appeals Coordinator

University of Virginia•Charlottesville, VA

2d•Onsite

About The Position

The CBO Appeals Coordinator handles complex appeals for denied claims, retro authorization appeals and/or underpayment reconsiderations for all facilities within UVA Health System or Professional Medical Groups. Coordinates with third party vendors for additional appeal support as needed. Provides appeals support for status of accounts that have been appealed with payors. This job requires the application and interpretation of policies and procedures and the use of independent judgment in a medical setting. The purpose is to achieve the CBO revenue cycle goals for the Health System and to ensure minimum loss of revenue and maximum payment for services rendered. The ability to maintain a working knowledge of carrier contracts/changes, clinical policy/procedures and departmental policies and procedures is required. The position requires the ability to effectively communicate the root cause of the denials back to departments within the Central Billing Office in order to prevent future losses. Analyzes information required to complete appeals with insurance carriers, service area contacts and workman’s compensation carriers for all facilities within UVA Health System or Professional Medical Groups. Demonstrates skill in the proficient use of UVA software systems to ensure appeal and/or retro-authorization information is entered into required computer systems and to the payors in an accurate and timely manner. Demonstrates the skills of effective communication, decision-making and organization to ensure efficient job performance and job success. Demonstrates ability to adhere to policies and procedures. Demonstrates high proficiency in Epic including but not limited to payor contracts and expected reimbursement calculations. Must be able to sufficiently understand the fundamentals of payor contracts at multiple hospital locations simultaneously and utilize the contracts to support appeal and reconsideration arguments. Demonstrates the ability to identify different payor trends for multiple hospital locations concurrently. Ability to communicate effectively and professionally with multiple provider reps to resolve underpayment trends efficiently. Proficient working knowledge of payor remittances to easily identify basis of underpayment received including but not limited to remark codes, DRG, SOI, CPT, HCPCS, etc, High level analysis to identify payor down coding, readmission reductions or incorrect contracts to efficiently determine the underpayment reason and the appropriate steps to resolution. Must work with outside departments when necessary to resolve the underpayment including but not limited to Billing, Payor Audits and Internal Appeals RN for clinical support.

Requirements

Associate degree required.
5 years of Revenue Cycle experience in lieu of Associates Degree, or Bachelor and 3 years of Revenue Cycle Experience required.
Coding Certificate preferred (Coding Certification must be obtained within 12 months of hire).
Application and interpretation of policies and procedures.
Use of independent judgment in a medical setting.
Maintain a working knowledge of carrier contracts/changes, clinical policy/procedures and departmental policies and procedures.
Effectively communicate the root cause of the denials back to departments within the Central Billing Office.
Proficient use of UVA software systems.
Effective communication, decision-making and organization skills.
Adherence to policies and procedures.
High proficiency in Epic including but not limited to payor contracts and expected reimbursement calculations.
Sufficient understanding of the fundamentals of payor contracts at multiple hospital locations simultaneously and utilize the contracts to support appeal and reconsideration arguments.
Ability to identify different payor trends for multiple hospital locations concurrently.
Proficient working knowledge of payor remittances to easily identify basis of underpayment received including but not limited to remark codes, DRG, SOI, CPT, HCPCS, etc,
High level analysis to identify payor down coding, readmission reductions or incorrect contracts to efficiently determine the underpayment reason and the appropriate steps to resolution.

Nice To Haves

Coding Certificate

Responsibilities

Handles complex appeals for denied claims, retro authorization appeals and/or underpayment reconsiderations for all facilities within UVA Health System or Professional Medical Groups.
Coordinates with third party vendors for additional appeal support as needed.
Provides appeals support for status of accounts that have been appealed with payors.
Analyzes information required to complete appeals with insurance carriers, service area contacts and workman’s compensation carriers for all facilities within UVA Health System or Professional Medical Groups.
Ensures appeal and/or retro-authorization information is entered into required computer systems and to the payors in an accurate and timely manner.
Communicates effectively and professionally with multiple provider reps to resolve underpayment trends efficiently.
Works with outside departments when necessary to resolve the underpayment including but not limited to Billing, Payor Audits and Internal Appeals RN for clinical support.