Description
Handles the end-to-end denial and appeal process, including the receiving, analyzing, recording, tracking, managing, and/or resolving appeals with third-party
payers in a timely manner.
Carries out appropriate research and analysis to help with the appeals process and stay informed with best practices and policy changes. Identifies, analyzes, and researches frequent root causes of denials and develops corrective action plans for resolution of denials.
Assists with cart audits as necessary.
Understands all ancillary department-charging functions.
Understands medical records, hospital bills and billing, and chargemaster.
Assists colleagues and participates in constructive interactions. Maintains professional and prompt communication with both internal and external clients.
Qualifications
Skills
Behaviors
:
Motivations
:
Education
Experience
Required
Understanding of medical and insurance terminologies, CPT and ICD coding
systems, and familiarity with billing forms.
At least two years of experience in healthcare revenue cycle, billing and collections,
processing payments, claim-related appeal writing, or denials management (denials
management experience preferred).