Appeals-Billing Specialist | Patient Financial Services, Full-Time

We are looking for a Appeals-Billing Specialist to join our collaborative team at Memorial Health! 

What You'll Do:

Appeals Management:

• Understands payer requirements per hospital contracts and payer policies, ensuring adherence to all payer requirements.
• Knowledge of payer contracts specific to timely filing deadlines and retro-authorization timelines
• Collaborates with various departments throughout the organization to confirm all necessary information for the appeal is accurate and supported through medical documentation.
• Collaborate with Billing Representatives to ensure appeals and/or additional documentation is provided timely for reimbursement, collecting data and creating appeal based on payer requirements.
• Reviews denial type, payor authorization approval information documented on the account, confirms timely claim submission as required by the payer
• Confirms coding, service admit and discharge dates, patient level of care and patient status are correct prior to appeal submission
• Maintains claims appeal logs, tracking to ensure payor reimbursement based on payor contract terms and payer specific rules
• Enters complete and appropriate account documentation in Health Information System (HIS) identifying all actions taken for all accounts
• Knowledge of all payer contract updates and provider bulletins pertaining to various appeal processes.
• Reviews Epic workqueue Appeals Communication for denied claims requiring an appeal
• Formulates appeal letters, assembles appropriate medical records, and other pertinent information necessary to complete the appeal process.
• Understanding of all tools necessary to process payor specific information; Real-Time Eligibility (RTE), MyAbility-Insurance Discovery, MyCGS, and so forth
• Knowledge of Current Procedure Terminology (CPT) and ICD-10 Diagnosis Codes
• Contacts guarantor and/or payor in the event clarification is needed

Specialty Billing for Sexual Assault Forensic Examination (SANE) Program & Medicare Short Stay:

• Serves as a liaison between Patient Financial Services and Emergency Department SANE coordinator to ensure billing is accurate and appropriate for claims submission to the Ohio State Attorney General’s Office.
• Prepare all documentation for SANE claim submission
• Manage and prepare all accounts for Medicare Short Stay claim billing through the various stages of the billing process in accordance with CMS billing guidelines.
• Track all Short Stay billing accounts, ensuring each step is accurate and timely.

Retro Authorization Management:

• Manage all retro authorizations when the Current Procedural Terminology (CPT) code on the claim does not match the code that was authorized with the payor; work queue Precert CPT not on Code Integration.

Requirements

1 - 3 years of hospital billing & claim appeals and hospital reimbursement experience preferred; associate or bachelor’s degree preferred. Knowledge of revenue cycle functions, registration experience, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired. Knowledge of hospital third party billing requirements, Current Procedural Terminology (CPT), International Classification of Disease (ICD)-9, ICD-10 and modifiers Knowledge of office practices and procedures, medical terminology, and the ability to communicate effectively. Must be proficient with Microsoft Word, Excel, and PowerPoint

Shift1st 

Hours80 per pay (every two weeks)

Benefits