Complex Denial Assistant

R1 RCM

1d•Onsite

About The Position

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Complex Denial Assistant, you will assist the complex denials staff in preparing and submitting complex and contractual appeals and letters to insurance companies. Every day, you will facilitate the organization/gathering/preparing of documents to be submitted with appeals or for administrative hearings. To thrive in this role, you must maintain clear written and oral communication with internal and external parties while assisting recovery staff in pursuing appeals.

Requirements

Assist the complex denials staff in preparing and submitting complex and contractual appeals and letters to insurance companies.
Facilitate the organization/gathering/preparing of documents to be submitted with appeals or for administrative hearings.
Maintain clear written and oral communication with internal and external parties while assisting recovery staff in pursuing appeals.

Nice To Haves

Paralegal certification with 1 year of experience in legal, insurance, or healthcare preferred.

Responsibilities

Investigate the facts of a denial and perform research into payor policies, state/Federal regulations, case law and precedents.
Apply provider specific reimbursement methodologies, payment policies and provider contracts to confirm payment in full.
Contact payors to conduct follow-up on pending appeals.
Meet performance standards and goals set by management.
Administrative duties or projects as assigned by Director or another member of leadership.
Independently manage assigned worklist with minimal oversight in compliance with established timelines.
Follow all HIPAA guidelines.