Overview
This role involves managing the follow-up process for payor responses to submitted appeals related to anesthesia services. The position requires coordination with insurance carriers to ensure timely payment and collection of funds due after the appeals process.
Responsibilities
- Coordinate payor denial and appeal follow-up activities to ensure timely responses from third-party payors.
- Process all payor denials, documentation requests, and appeals for both institutional and professional claims.
- Communicate and coordinate with various stakeholders to monitor day-to-day appeal follow-up and denial activities.
- Maintain the hospital tracking tool/application that manages all denial and review activity, including user access management, software updates, and end-user training.
- Collect, analyze, and report status, metrics, and trends of activities from multiple systems; develop routine reports for specific distribution groups.
- Organize data and activities to ensure timely follow-up on appeals to third-party payors.
- Assist with coordination of denial and review activities and materials for committee meetings, including analyses and reports.
- Support projects and initiatives of the Revenue Integrity team, including coordinating meetings, conducting payor criteria research, and preparing documents.
- Deliver high-quality work with strong communication skills.
Additional duties and participation in special projects may be required.
Requirements
- 5-7 years of experience in a healthcare patient accounting revenue cycle environment.
- Minimum 3 years of related anesthesia experience.
- Knowledge of hospital revenue cycle revenue management and EDI transaction sets including 837I, 837P.
- Understanding of insurance contract rates and terms.
- Familiarity with registration and collections processes.
- Understanding of government and managed care billing, coverage, and payment rules.
- Ability to interpret payor 835 and paper Explanation of Benefits (EOB) responses.
- Knowledge of CCI edits, CPT, HCPCS, ICD-10, and revenue codes.
- Experience with Epic EMR (HB and/or PB).
- Bachelor's degree or equivalent combination of education and experience.
Preferred Qualifications
- 3 years of experience in hospital third-party collections/accounts receivable.
Compensation & Benefits
- Medical coverage eligibility begins on the first day of employment.
- Eligibility for 403(b) and Roth 403(b) Retirement Savings Plan with matching contributions up to 6% after one year of service.
- Paid time off, life insurance, short-term and long-term disability, Flexible Spending Account (FSA), and Health Savings Account (HSA) options for full-time or part-time employees working 40+ hours per pay period.
- Additional benefits for eligible employees include tuition reimbursement, home and auto insurance, hospitalization, critical illness, pet insurance, and more.
- Coverage extends to employees and qualified dependents, subject to plan terms and state laws.
Location
Position location details were not specified.