R1 RCM · 5 hours ago

US-Denials & AR Analyst II-4

Remote, USA

Full-time

Remote

Entry, Mid Level

$17.81/hr - $25.89/hr

2+ years exp

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Health CareHospital

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Responsibilities

Resolve, call and/or appeal a defined number of accounts per day as instructed by leadership.

Complete Initial Reviews and Validations as assigned.

Draft appeals and letters to insurance companies.

Calculate expected claim reimbursement.

Make proper notations in software system on all accounts.

Understand and utilize payer contracts and provider manuals when disputing denials.

Use proper approved note structure when notating all accounts.

Follow up on all appeals, claims, letters, or other documentation within 20 days or less of the submission.

Follow up on all payments at the time an overturn is received.

Demonstrate an understanding of office workflow by completing necessary required fields correctly.

Use available resources appropriately, including but not limited to training materials, shared drive, team meeting notes, etc.

Ensure that assigned accounts are appealed timely using an internal worklist.

Maintain worklist through daily audits and the open task report.

Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.

Address all follow ups promptly.

Alerts must be addressed within a day of receipt.

Initial call requests must be addressed within two days from the receipt of the follow up.

Follow ups should never be more than 14 days old.

Handle RUSH cases appropriately.

Maintain one follow up in each assigned account and refrain from unnecessary duplicate follow ups on worklist.

Obtain prior approval from a Lead, Supervisor, or Manager for all modifications to a UB-04; including, but not limited to, additions, changes or removals to/from the original claim provided by the facility.

Follow all HIPAA guidelines in accordance with Employee Handbook.

Qualification

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Claims ManagementInsurance Appeals

Required

Bachelor's degree from four-year college or university with at least two years related experience; or three to five years related experience and/or training; or equivalent combination of education and experience.