To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Reporting to the Manager of Denials & Quality Assurance, this position is responsible for all phases of Audit and Appeal initiation, follow up and closure using accepted practices to ensure thorough and consistent processes to promote financial health. Responsible to work collaboratively and communicate effectively with payers and departments within the Health System Finance division to provide timely and accurate account resolution in accordance with established guidelines and timeframes.
- 1. Reviews payer correspondence regarding clinical denials.
- 2. Processes appeal correspondence and related medical record documentation by mail, portal or other means as applicable for each phase of the appeal cycle.
- 3. Review and interpret information from EOB's, audit letters, denial letters, and other dispute documentation.
- 4. High volume phone calls and utilizes payer portals to follow up on appeals throughout the entire process, obtain decisions as efficiently possible.
- 5. Communicates with payers/payer representatives or other stakeholders to request needed documents and follow up on pending appeals.
- 6. Escalates cases through the proper channels in accordance with established procedure.
- 7. Works with appeals team to identify trends and root causes.
- 8. Maintains accurate, clear, timely documentation utilizing all related audit tracking and electronic health record information systems.
- 9. Responsible for maintaining daily account follow-up and related work lists maintaining organization productivity standards.
- 10. Ensures timely receipt and reconciliation of payer payments.
- 11. Ability to adjust to changing workloads and needs of the position by, but not limited to assisting other teams of fellow employees and adjusting working hours as needed.
- 12. Perform other duties as assigned.
High School Diploma or equivalent; Certified Medical Coder (CMC) or Registered Health Information Technology (RHIT) preferred.
Minimum of two years? healthcare revenue cycle experience in a hospital setting. Formal training or college coursework from a medical coding accredited school, specific to medical billing in lieu of experience may be considered.
Familiarity with medical terminology, general understanding of the revenue cycle and appeals process, excellent communication skills and attention to detail, ability to work independently and as part of a team, willingness to learn new skills, ability to concentrate intensely at times. Experience with Epic, knowledge of coding guidelines and coding edits a plus. Critical thinking skills, excellent communication skills, ability to multi-task and attention to detail are required and essential.