Revenue Recovery Appeal Assistant

Advocate Health and Hospitals Corporation•Rome, GA

19h•Remote

About The Position

The Revenue Recovery Appeal Assistant is responsible for updating financial and audit tracking systems with the financial outcomes of payer audits. This role involves reconciling financial data, entering outcomes, updating missing or incorrect fields, and communicating with billing teams for rebills. The assistant will monitor and investigate automated RAC denials, review medical records for appeals, and identify denial validity. They will prepare and submit governmental and non-governmental appeals, ensuring timely submission with adequate documentation. The position requires determining the reason for denial, writing appeal letters, and monitoring systems for additional development requests (ADRs). The assistant will also analyze reports, maintain productivity logs, and potentially train new associates.

Requirements

High School Graduate or equivalent
Typically requires 3 years of experience in hospital/physician coding, revenue cycle, payer contracting, billing/collections, database management.
Electronic Health Record and revenue cycle systems
Hospital and Physician Group revenue cycle operations and systems
Demonstrated knowledge of regulatory audit process
Effective written and verbal communications skills.
Ability to work well within a team atmosphere.
Self-motivation
Knowledge of hospital reimbursement, hospital managed care contracts; government payer reimbursement regulations
Knowledge and experience using Hospital clinical systems and Microsoft applications
Knowledge of Hospital coding: HCPCS, CPT, Revenue Codes, DRGs; experience with hospital charge description masters (CDMs)
Ability to operate scanner/copier, fax
Must comply with AAH Remote work policy

Responsibilities

Update financial and audit tracking systems with financial outcomes for all government and non-government payer audits.
Reconcile financial data in billing systems (Epic, Allegra, Star, Cerner, IDX).
Enter financial outcomes for each pertinent case in the audit tracking database.
Update missing and/or incorrect fields in the audit tracking database.
Reconcile financial and audit tracking systems when payments or denials are received.
Communicate to appropriate billing team to complete a Part A to Part B rebill.
Monitor and investigate all automated RAC (RAC-A) denials as well as automated RAC denials for other governmental claims.
Review and obtain all pertinent medical record documentation needed for responding for initial audit, Discussion, and Appeal requests.
Identify automated RAC denials via Medicare remittance data or other automated process (FISS), NGS Connex.
Review automated RAC denial for validity.
Collaborate with Denial Coordinators and if denial needs to be corrected.
Communicate automated RAC denial activity to leadership and team members.
Update the financial systems and all other pertinent systems such as the audit tracking database with appropriate notes.
Prepare and submit Governmental & Non-Governmental appeals when appropriate.
Upload appeal documents, update audit tracking database, and financial systems.
Ensure appeals are submitted with adequate supporting documentation and that the appeal is sent timely from date of denial.
Submit appeal and monitor claim for repayment.
Using knowledge of Medicare (or other governmental payors) billing requirements, determine if denial should be appealed.
Determine the reason for denial on specific claims.
Update financial and audit tracking database.
Write Governmental & Non-Governmental appeal letters as needed.
Monitor FISS or other automated system(s) for Additional Development/Documentation Requests (ADRs) for Government audits received.
Identify Prepayment/Post Payment Additional Development Requests via FISS on a daily basis.
Create regulatory audits, and upload ADR(s) that are received in audit tracking database.
Update the ADR spreadsheet on Shared G: Drive for all prepayment regulatory audits received via FISS.
Monitor FISS for prepayment audit denials.
On a daily basis review all Medicare remittance, FISS, and other automated system(s) for prepayment/Post Payment audit denials.
Identify the corresponding denial reason code and remarks.
Upload FISS MAPs as needed to process denials into the audit tracking database.
Update the auditor decision, enter note, and process through the workflow in the audit tracking database.
Monitor all Governmental & Non-Governmental audit denials.
Provide information as needed in an accurate and time sensitive manner to support the appeals process.
On a daily basis review all Medicare remittance data and FISS for RAC, MAC, and CERT denials.
Process cases identified on the RAC Recovery Report emails that are received on a daily basis.
Communicate RAC, MAC, and CERT denial activity on a daily basis to Regulatory Integrity management.
Ensure that the financial and all other pertinent systems such as the audit tracking database documentation clearly indicate the nature and outcome of the denial.
Run and analyze reports in audit tracking database.
Perform other duties as needed when appropriate.
Fax, scan, email, print, copy.
Create cases in the audit tracking database.
Keep daily productivity log up to date.
Contact Governmental & Non-Governmental auditors and contractors.
Train new and/or existing associates.

Benefits

Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program