Accesses numerous programs utilized for the collection and reporting of claim data required to maintain tracking and logging systems. (Business Warehouse, Meditech, FISS, SSI, Virtual Folder, On Base)
Coordinates various aspects of the appeal process.
Reviews for completeness and quality of denials entries, including but not limited to appeal requests, deadlines, outcomes, and status.
Monitors response of claim audits to identify trends in requested records.
Monitors response of claim audits to identify trends in over and under payment results.
Coordinates with key Revenue Cycle Leadership regarding denied claims to provide relevant statistics about dollars at risk. Support the field with interpretation of denial documentation and activity.
Reviews periodicals, web sites and other media for changes in current appeal guidelines.
Provides assistance to the Central Billing Offices and hospital staff regarding clinical denials
Ensures correspondance related to clinical denials is scanned in the applicable system of record.
Monitors AR accuracy based on expected reimbursement, works with key Revenue Cycle team members to ensure denied AR is booked correctly.
Assists in follow-up activity when necessary.
Monitors accounts with payer exhausted appeal options.
Facilitates clinical reviews on high dollar accounts.
Excellent oral and written communication and interpersonal skills.
Approximate percent of time required to travel: <5%
5+ years experience in hospital setting, claim billing experience required
Depending on a candidate's qualifications, this position may be filled at a different level.
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