Revenue Recovery Appeals Assistant

Advocate Health • Winston-Salem, NC

6d • $25 - $38

About The Position

The Revenue Recovery Appeals Assistant supports revenue recovery audit operations by reconciling financial and audit tracking systems, reviewing governmental and non-governmental payer audit activity, and preparing and submitting appeals. The role monitors audit denials and documentation requests, gathers medical records and supporting documentation, updates case and financial systems, and tracks appeals through submission and repayment. The position works with billing teams, denial coordinators, auditors, contractors, and Regulatory Integrity leadership, and may also train associates and perform related administrative duties.

Requirements

• High school graduate or equivalent.
• Typically requires 3 years of experience in hospital/physician coding, revenue cycle, payer contracting, billing/collections, or database management.
• Knowledge of electronic health record and revenue cycle systems.
• Knowledge of hospital and physician group revenue cycle operations and systems.
• Demonstrated knowledge of the regulatory audit process.
• Effective written and verbal communication skills.
• Ability to work well within a team atmosphere and self-motivation.
• Knowledge of hospital reimbursement, hospital managed care contracts, and government payer reimbursement regulations.
• Knowledge and experience using hospital clinical systems and Microsoft applications.
• Knowledge of hospital coding, including HCPCS, CPT, revenue codes, and DRGs, and experience with hospital charge description masters (CDMs).
• Ability to operate a scanner/copier and fax machine.
• Must comply with the AAH Remote Work Policy.

Nice To Haves

• Medicare billing and follow-up experience.

Responsibilities

• Reconcile financial data across billing systems and the audit tracking database, enter audit financial outcomes, and correct missing or inaccurate tracking fields.
• Reconcile systems when payments or denials are received and communicate with the appropriate billing team when a Part A to Part B rebill is needed.
• Monitor and investigate automated RAC and other governmental audit denials; identify denials using Medicare remittance data, FISS, NGS Connex, or other automated systems.
• Review denials for validity, coordinate with Denial Coordinators when corrections are needed, and communicate denial activity to leadership and team members.
• Obtain medical record documentation needed for initial audits, discussions, and appeals.
• Prepare and submit governmental and non-governmental appeals, write appeal letters as needed, upload supporting documents, update systems, and monitor claims for repayment.
• Determine denial reasons and whether an appeal is appropriate based on knowledge of Medicare and other governmental payer billing requirements.
• Monitor FISS and other automated systems for Additional Development/Documentation Requests, create regulatory audit cases, upload requests, and update the shared ADR spreadsheet.
• Review Medicare remittance data, FISS, and other automated systems daily for prepayment and post-payment audit denials; identify denial codes and remarks and process cases in the audit tracking workflow.
• Review RAC, MAC, and CERT denials, process cases identified through daily RAC Recovery Report emails, and communicate activity to Regulatory Integrity management.
• Ensure financial and audit tracking systems document the nature and outcome of denials, and run and analyze audit tracking database reports.
• Perform related administrative tasks, including faxing, scanning, emailing, printing, copying, creating cases, and maintaining a daily productivity log.
• Contact governmental and non-governmental auditors and contractors and train new or existing associates.

Benefits

• Paid Time Off programs.
• Medical, dental, vision, life, and short- and long-term disability benefits.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.
• Competitive compensation, potential premium and incentive pay for eligible positions, and opportunity for annual performance-based increases.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED