Denials/Appeals Analyst SRCO

Department:
10299 Enterprise Revenue Cycle - Revenue Recovery Appeals: MW

Status:
Full time

Benefits Eligible:
Yes

Hou rs Per Week:
40

Schedule Details/Additional Information:

Totally remote full-time position.

Pay Range:
$26.55 - $39.85

Major Responsibilities:

- Researches and analyzes denied claims to ensure compliance with payor and/or government rules/regulations and determines appropriateness for appeal.
- Secures needed medical documentation required or requested by insurance carriers to support appeal process.
- Reviews and analyzes accounts; determines and writes appeal letters for technical appeals based on medical necessity.
- Collaborates with staff as needed on issues related to denials.
- Prepares claims for clinical appeal processing in the case of authorization and medical necessity denials.
- Prepares documents utilizing provider billing manuals to obtain billing guidelines and requirements and shares information as needed.
- Prioritizes appeals according to filing limitations established by the individual payor contracts. Responsible for ongoing documentation of denial status in denial software.
- Identifies and analyzes payor trends/issues and communicates with leadership on findings.
- Meets monthly with Denial Prevention Advisor to go over trends in denial categories and providing feedback for opportunities to increase revenue.
- Maintains a caseload and monitors day to day compliance of appeal decision time frames.

Licensure, Registration, and/or Certification Required:

- None Required.

Education Required:

- Bachelor's Degree in Finance, or related field, or equivalent knowledge.

Experience Required:

- Typically requires 3 years of experience in Hospital billing, finance, medical necessity denials management, coding or related field.

Knowledge, Skills & Abilities Required:

- Experience with current CPT and HCPCS coding nomenclature and rules, ICD-9/ICD10 coding conventions and clinical documentation standards.
- Previous clinical documentation and chart review experience along with understanding of medical terminology.
- Knowledge of appeals criteria and understanding of federal, state and local regulations.
- Excellent critical thinking and analytical skills, with a high attention to detail.
- Ability to meet deadlines while working in a fast paced environment.
- Ability to take initiative and work collaboratively with others.
- Strong computer skills, including high proficiency with Microsoft Office Suite.
- Desire to Enhance Knowledge, skills and abilities.
- Excellent writing skills necessary to facilitate the advanced appeal process.

Physical Requirements and Working Conditions:

- Operates all equipment necessary to perform the job.
- Exposed to a normal office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

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

Benefits and more

- 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

Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.

About Advocate Health

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.