Revenue Recovery PB Follow Up Representative

Monday through Friday Days with some flexibility

This is a REMOTE position

Major Responsibilities:

• Researches and analyzes denied claims to ensure compliance with payor and/or government rules/regulations and determines appropriateness for appeal.
• Secures needed medical documentation required or requested by insurance carriers to support appeal process.
• Reviews and analyzes accounts; determines and writes appeal letters for technical appeals based on medical necessity.
• Collaborates with staff as needed on issues related to denials.
• Prepares claims for clinical appeal processing in the case of authorization and medical necessity denials.
• Prepares documents utilizing provider billing manuals to obtain billing guidelines and requirements and shares information as needed.
• Prioritizes appeals according to filing limitations established by the individual payor contracts. Responsible for ongoing documentation of denial status in denial software.
• Identifies and analyzes payor trends/issues and communicates with leadership on findings.
• Meets monthly with Denial Prevention Advisor to go over trends in denial categories and providing feedback for opportunities to increase revenue.
• Maintains a caseload and monitors day to day compliance of appeal decision time frames.

Licensure, Registration, and/or Certification Required:

• None Required.

Education Required:

• Bachelor's Degree in Finance, or related field, or equivalent knowledge.

Experience Required:

• Typically requires 3 years of experience in Hospital billing, finance, medical necessity denials management, coding or related field.  

Knowledge, Skills & Abilities Required:

• Experience with current CPT and HCPCS coding nomenclature and rules, ICD-9/ICD10 coding conventions and clinical documentation standards. 
• Previous clinical documentation and chart review experience along with understanding of medical terminology. 
• Knowledge of appeals criteria and understanding of federal, state and local regulations.
• Excellent critical thinking and analytical skills, with a high attention to detail.
• Ability to meet deadlines while working in a fast paced environment.
• Ability to take initiative and work collaboratively with others. 
• Strong computer skills, including high proficiency with Microsoft Office Suite.
• Desire to Enhance Knowledge, skills and abilities.
• Excellent writing skills necessary to facilitate the advanced appeal process.

Physical Requirements and Working Conditions:

• Operates all equipment necessary to perform the job.
• Exposed to a normal office environment.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.