[Hiring] Revenue Recovery Appeals Assistant @Advocate Health

Role Description

The primary responsibilities of this role include:

• Update financial and audit tracking systems with financial outcomes for all government and non-government payer audits.
• Reconcile financial data in billing systems (Epic, Allegra, Star, Cerner, IDX).
• Enter financial outcomes for each pertinent case in the audit tracking database.
• Update missing and/or incorrect fields in the audit tracking database.
• Reconcile financial and audit tracking systems when payments or denials are received.
• Communicate with the appropriate billing team to complete a Part A to Part B rebill.
• Monitor and investigate all automated RAC (RAC-A) denials and other governmental claims.
• Review and obtain all pertinent medical record documentation needed for audits.
• Identify automated RAC denials via Medicare remittance data or other automated processes (FISS, NGS Connex).
• Collaborate with Denial Coordinators to correct denials as needed.
• Communicate automated RAC denial activity to leadership and team members.
• Prepare and submit Governmental & Non-Governmental appeals when appropriate.
• Upload appeal documents and update the audit tracking database and financial systems.
• Ensure appeals are submitted with adequate supporting documentation and in a timely manner.
• Monitor FISS or other automated systems for Additional Development/Documentation Requests (ADRs).
• Create regulatory audits and upload ADRs in the audit tracking database.
• Monitor FISS for prepayment audit denials and identify corresponding denial reason codes.
• Provide information to support the appeals process in an accurate and timely manner.
• Run and analyze reports in the audit tracking database.
• Perform other duties as needed, including faxing, scanning, emailing, printing, copying, and creating cases in the audit tracking database.
• Keep daily productivity logs up to date and contact Governmental & Non-Governmental auditors and contractors.
• Train new and/or existing associates.

Qualifications

• High School Graduate or equivalent.
• Typically requires 3 years of experience in hospital/physician coding, revenue cycle, payer contracting, billing/collections, database management.

Requirements

• Knowledge of Electronic Health Record and revenue cycle systems.
• Understanding of hospital and physician group revenue cycle operations and systems.
• Demonstrated knowledge of regulatory audit processes.
• Effective written and verbal communication skills.
• Ability to work well within a team atmosphere.
• Self-motivation.
• Knowledge of hospital reimbursement and government payer reimbursement regulations.
• Experience using hospital clinical systems and Microsoft applications.
• Knowledge of hospital coding: HCPCS, CPT, Revenue Codes, DRGs; experience with hospital charge description masters (CDMs).
• Ability to operate scanner/copier, fax.
• Must comply with AAH Remote work policy.

Benefits

• Base compensation within the listed pay range based on 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.