[Hiring] Denials/Appeals Analyst @Advocate Health

Role Description

This is a totally remote full-time position.

• 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.

Qualifications

• Bachelor's Degree in Finance, or related field, or equivalent knowledge.
• Typically requires 3 years of experience in hospital billing, finance, medical necessity denials management, coding or related field.

Requirements

• 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.

Benefits

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training.
• Premium pay such as shift, on call, and more based on a teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.
• Paid Time Off programs.
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.