Responsible for supporting management in investigating denied or underpaid inpatient and outpatient claim by reviewing EOBs, medical records, and account notes to determine specific reason for denial. Collaborate with other departments and appeal to vendors to ensure appropriate reimbursement, identify denial trends and document accurate findings. Follow up with insurance companies to check status of appeals and provide additional information as needed.
Print and mail appeals.
Claim review and analysis: Investigate denied or underpaid claims by reviewing EOBs, medical records, and account notes to determine the specific reason for the denial. Appeal preparation: Forward denied encounters to appropriate dept/vendor for written appeal with supporting documentation rationale. Print and mail appeals Payer communication: Follow up with insurance companies to check the status of appeals and provide additional information as needed.
Trend identification: Identify root causes for denials and report recurring issues to management to help prevent future denials. Process improvement: Collaborate with other teams, such as billing and clinical staff, to implement process improvements that reduce avoidable denials. Record keeping: Maintain detailed and accurate records of all denial and appeal activities in the system, including all communications and actions taken.
Record outcome and adjust balances in Epic Reconcile invoices from vendor
Minimum: High school diploma Other Desired Skills, Abilities, and Knowledge Analytical
Ability to analyze complex data, identify trends, and make informed decisions. Communication
Strong written and verbal communication skills for collaborating with internal and external stakeholders. Problem-solving: Critical thinking and problem-solving skills to navigate complex denial reasons. Organizational
Ability to manage a large caseload, prioritize tasks, and meet deadlines. Attention to detail: Meticulous attention to detail to ensure accuracy in documentation.
Full-Time