AR Denial Management & Appeals Specialist, 250 E. Liberty St, 8a-430p

Initiates the appeal process, at the direction of Revenue Cycle management, until the case is overturned, appeal options are exhausted, or decision is made to discontinue process.  This position assumes the responsibility for coordinating and appealing technical denials and working closely with Clinical Appeals Specialists responsible for clinical appeals. 

• Ability to review and determine reason for insurance denial of claims
• Review and appeal unpaid claims daily and submit appeal timely.
• Develop appeal letters to substantiate overturning denial, i.e. coverage, authorization, non-covered services, contract issues, timely filing limit, etc.
• Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for Revenue Cycle leadership
• Completes follow-up work on appealed claims.
• Works with insurance carriers on appeal issues.
• Ensure clinical appeals are submitted to the appropriate department
• Monitoring the payments to ensure reimbursement from third-party payers is accurate based on payer contract.
• Reviews denials for accuracy.
• Stays abreast of payer updates for authorizations, eligibility, etc. and communicates to Revenue Cycle leadership
• Document all activity in designated Revenue Cycle system
• Attends continuing education programs
• Other duties as assigned

• Maintains compliance with all company policies, procedures and standards of conduct
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
• Performs other duties and employment requirements as assigned.

• High School education or GED required.

• 1-3 years of prior billing, collection, or appeals

Knowledge, Skills, and Abilities critical to this role:

• Knowledge of medical terminology.
• Clear and concise written communication skills and development of professional letters.
• Basic Microsoft Office knowledge.
• Ability to foresee projects from start to finish.

Additional Responsibilities:

• Sedentary Work: Lifting 10lbs. maximum and occasionally lifting and/or carrying items as needed.
• Frequent Talking (Expressing or exchanging ideas by means of the spoken word.)
• Frequent Hearing (Perceiving the nature of the sounds by the ear.)
• Frequent Seeing (Visual acuity, depth perception, field of vision, color vision).
• Consistent use of hand movement for keyboarding purposes.
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community