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Managed Care Appeals Analyst

Remote:

Full Remote

Contract:

Full time

Experience:

Mid-level (2-5 years)

Work from:

United States

Offer summary

Qualifications:

Associate or bachelor’s degree in related field, Minimum one year healthcare auditing experience, 4+ years revenue cycle and appeals writing experience, Proficient in reimbursement methodologies and claims analysis, Intermediate skills in Microsoft applications.

Key responsabilities:

Research closed accounts for underpayment amounts
Create detailed appeals for payment discrepancies
Contact payors for eligibility and claims issues
Monitor payments and document account research
Ensure compliance with policies and HIPAA standards

Elevate Patient Financial Solutions® Large https://www.elevatepfs.com/

1001 - 5000 Employees

See more Elevate Patient Financial Solutions® offers

Job description

Elevate Patient Financial Solutions has an exciting career opportunity available as a Managed Care Appeals Analyst.

This position will be Remote Work from Home.

The full time schedule for the position will be Monday - Friday 8 hours a day.

Job Summary

The Managed Care Appeals Analyst will research closed - $0 balance accounts for underpayment amounts due from payors per established contracts. Appeal Analysts ensure that payments made are accurate and in full per the contract agreements identifying and reporting payor trends through established policies & procedures. This position also creates 1st and 2nd level appeals when accounts are not reimbursed according to established contracts.

Essential Duties And 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.

Qualifications And Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities.

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.
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.
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.

Benefits

ElevatePFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.

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

The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.

Elevate, PFS is an Equal Opportunity Employer