Address
Form of workSPECIFIC JOB DEMANDS
REVIEWS accounts to determine if appeal was accepted or denied.
Contact various insurance companies either electronically or by paper in a timely manner.
Responds to telephone calls and messages from patients, insurance companies and staff courteously and promptly with an emphasis on effective resolution.
Reviews accounts to see if payment has been received and keep documentation log
Send spreadsheets when available to payer contacts for appeals over 60 days
Two midnight rules and payer applications.
Knowledge of Medicare rules
Demonstrates knowledge of organizational policies regarding insurance appeals
Generates special reports as needed.
Upload all faxes, letters and appeal letters to the account in care manager.
Demonstrates knowledge of various insurance programs regarding covered and non-covered services.
Knows how to contact payers for their readmission policies
Notifies administrative personnel of important situations or problems.
Prepares monthly reports on all appeals and if we have won or lost
Run reports on the appeals done through UM and the medical director
Routinely performs established follow-up procedures documenting actions throughout the process.
Ensures compliance in all regulatory areas.
Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
Reviews payer rules with UM nursing staff
Monthly meetings with medical director and UM management on appeals and results
Work with HIM and understand their process for release of information
Obtain access to MRO to obtain dates when appeal was sent and received.
Organization skills needed to maintain all the appeals being perform
Identify denials out MD audit for DRG payments and report to CDI staff when DRG is different
Performs other duties as assigned
MINIMUM EDUCATION, KNOWLEDGE, SKILLS, AND ABILITIES REQUIRED
High school graduate or equivalent.
Knowledge of medical billing
Knowledge of different payers and policies
Knowledge of computer programs.
Knowledge of business office procedures.
Knowledge of basic medical coding and third-party operating procedures and practices.
Ability to operate a computer and basic office equipment.
Ability to operate a multi-line telephone system. Skill in answering a telephone in a pleasant and helpful manner.
Ability to read, understand and follow oral and written instructions.
Ability to establish and maintain effective working relationships with patients, employees and the public.
Must be well organized and detail-oriented.
