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Elevate Patient Financial Solutions® · 1 month ago

Managed Care Appeals Analyst

United States

Contract

Remote

Mid, Senior Level

$24/hr - $30/hr

4+ years exp

Elevate Patient Financial Solutions is offering a career opportunity as a Managed Care Appeals Analyst. The role involves researching closed accounts for underpayment amounts and creating appeals when accounts are not reimbursed according to established contracts.

Business IntelligenceHealth CareInformation Technology

Responsibilities

Perform daily, systematic reviews of $0 balance accounts for the appropriate contractual reimbursement

Post adjustments and patient responsibility at time of account review

Use payor contract, remit, and audit note to troubleshoot and/or identify reimbursement efficiencies

Create high level, detailed appeals that specifically identify what service(s) were not paid accurately and locate supporting information in the payor contract to submit with the appeal

Contact identified payor sources to confirm eligibility, coordination of benefits, patient responsibility, DRG, APR-DRG, and any other denial or claims issue not clearly identified or understood

Navigate payor portals to verify eligibility, claim status, coordination of benefits, track and monitor submitted appeals

Monitor payments for accuracy, contacting payor to resolve outstanding amounts, recoupments, RAC Audits, or overpayments

Accurately document outcome of all research and work performed on accounts in the system in accordance with Standard Operating Procedures

Consistently meet the current productivity standards in ensuring accounts are appealed properly and accurately as assigned by leadership

Enhance professional growth and development through bridge online learning, and weekly team meetings

Complies with client, departmental, and organizational policies and procedures as they relate to the job

Refers complex or sensitive issues to the attention of the supervisor to ensure corrective measures are taken in a timely fashion

Accepts and learns new tasks as required and demonstrates a willingness to work where business needs are largest

Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices

Be cross trained in multiple clients and hospital system platforms

Communicate in a professional with fellow coworkers, clinical staff, coders, supervisors, and representatives from payor organizations

Follow departmental guidelines for lunch, breaks, requesting time off, and shift assignments

Regular and timely attendance

Perform other duties as assigned

Qualification

Healthcare auditing experienceRevenue cycle knowledgeReimbursement methodologiesClaims data analysisMicrosoft applications proficiencyHIT systems understandingMedical billing terminologyFormal business communicationTeamworkAdaptability

Required

Associate or bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or closely related field or in lieu of degree, four (4) additional years of relevant work experience may be considered

Minimum of one (1) year healthcare related experience in auditing

4+ years recent revenue cycle, hospital reimbursement, Ambulatory Surgical Center, Behavioral Health, third party payor contracting, and appeals writing

4+ years proficient knowledge of reimbursement methodologies such as DRG, EAPG, OPPS and APC

4+ years analyzing claims data applying knowledge of medical policy such as NCCI and MUE edits to determine details of overpayments

Ability to identify, understand and use general medical billing terminology including: UB04, CPT Codes, ICD10 codes, DRG codes APR-DRG Codes, EOB, RA

Must be able to formulate and write formal business communications to commercial and governmental payors

Remote and Hybrid positions require a home internet connection that meets the company's upload and download speed criteria

Preferred

Intermediate skills in Microsoft applications: spreadsheets, word processing, data base applications, and knowledge of billing system applications preferred

Basic understanding of HIT systems like EPIC, Cerner, Meditech, Paragon and other billing systems

Benefits

Medical, Dental & Vision Insurance

401K (100% match for the first 3% & 50% match for the next 2%)

15 days of PTO

7 paid Holidays

2 Floating holidays

1 Elevate Day (floating holiday)

Pet Insurance

Employee referral bonus program

Teamwork: We believe in teamwork and having fun together

Career Growth: Gain great experience to promote to higher roles

Company

Elevate Patient Financial Solutions®

Elevate Patient Financial Solutions® is a trusted partner who delivers superior RCM solutions to hospitals, health systems, and health providers nationwide.

Founded in 1980

Spring, Texas, USA

1001-5000 employees