Follow-Up Team Lead

at R1 RCM in Boise, Idaho, United States

Location: Remote, USA

Shift: Flexible start time 6:00AM-9:00AM, 8.5 hour shifts, Monday-Friday. Training schedule may differ from the standard scehdule.

R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1 is publicly traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization's infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Follow Up Associate will be responsible for reviewing audits will apply appropriate methods and techniques as established internally to resolve applicable issues, follows through with unresolved audits, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply to the positions entailed duties and be able to trouble-shoot issues as they arise within the assigned specialization group. In addition, this position is required to learn how to conduct research analysis and work closely with third party payers to answer relevant questions and obtain appropriate information in pursuit of resolving assigned claims. Follow Up Associates must be assessed as being resourceful and having extensive knowledge in area applicable to the assigned specialization group. Acts under direct supervision while learning to make complex decisions within the scope of this position.

Responsibilities:

+ Investigates and examines source of denials utilizing knowledge of AS400, Cerner, ICD-10 coding, CPT coding and EDI billing

+ Reads and interprets expected reimbursement information from EOB's and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB

+ Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission

+ Works with HIM, Compliance, RI, and PAS across the enterprise in resolving adverse benefit determinations

+ Work closely with Appeals staff