[Remote] Managed Care Appeals Analyst

Note: The job is a remote job and is open to candidates in USA. Elevate Patient Financial Solutions is seeking a Managed Care Appeals Analyst to join their team. This role involves researching underpayment amounts from payors, creating appeals for reimbursement discrepancies, and ensuring compliance with contractual agreements.

Responsibilities

• Perform daily, systematic reviews of $0 balance accounts for the appropriate contractual reimbursement
• Post adjustments and patient responsibility at time of account review
• Use payor contract, remit, and audit note to troubleshoot and/or identify reimbursement efficiencies
• Create high level, detailed appeals that specifically identify what service(s) were not paid accurately and locate supporting information in the payor contract to submit with the appeal
• Contact identified payor sources to confirm eligibility, coordination of benefits, patient responsibility, DRG, APR-DRG, and any other denial or claims issue not clearly identified or understood
• Navigate payor portals to verify eligibility, claim status, coordination of benefits, track and monitor submitted appeals
• Monitor payments for accuracy, contacting payor to resolve outstanding amounts, recoupments, RAC Audits, or overpayments
• Accurately document outcome of all research and work performed on accounts in the system in accordance with Standard Operating Procedures
• Consistently meet the current productivity standards in ensuring accounts are appealed properly and accurately as assigned by leadership
• Enhance professional growth and development through bridge online learning, and weekly team meetings
• Complies with client, departmental, and organizational policies and procedures as they relate to the job
• Refers complex or sensitive issues to the attention of the supervisor to ensure corrective measures are taken in a timely fashion
• Accepts and learns new tasks as required and demonstrates a willingness to work where business needs are largest
• Demonstrate knowledge of HIPAA privacy standards and ensure compliance with system PHI privacy practices
• Be cross trained in multiple clients and hospital system platforms
• Communicate in a professional with fellow coworkers, clinical staff, coders, supervisors, and representatives from payor organizations
• Follow departmental guidelines for lunch, breaks, requesting time off, and shift assignments
• Regular and timely attendance
• Perform other duties as assigned

Skills

• Associate or bachelor's degree in Accounting, Finance, Business Administration, Healthcare Administration, or closely related field or in lieu of degree, four (4) additional years of relevant work experience may be considered
• Minimum of one (1) year healthcare related experience in auditing
• 4+ years recent revenue cycle, hospital reimbursement, Ambulatory Surgical Center, Behavioral Health, third party payor contracting, and appeals writing
• 4+ years proficient knowledge of reimbursement methodologies such as DRG, EAPG, OPPS and APC
• 4+ years analyzing claims data applying knowledge of medical policy such as NCCI and MUE edits to determine details of overpayments
• Intermediate skills in Microsoft applications: spreadsheets, word processing, data base applications, and knowledge of billing system applications preferred
• Basic understanding of HIT systems like EPIC, Cerner, Meditech, Paragon and other billing systems
• Ability to identify, understand and use general medical billing terminology including: UB04, CPT Codes, ICD10 codes, DRG codes APR-DRG Codes, EOB, RA
• Must be able to formulate and write formal business communications to commercial and governmental payors
• Remote and Hybrid positions require a home internet connection that meets the company's upload and download speed criteria
• Intermediate skills in Microsoft applications: spreadsheets, word processing, data base applications, and knowledge of billing system applications preferred

Benefits

• Medical, Dental & Vision Insurance
• 401K (100% match for the first 3% & 50% match for the next 2%)
• 15 days of PTO
• 7 paid Holidays
• 2 Floating holidays
• 1 Elevate Day (floating holiday)
• Pet Insurance
• Employee referral bonus program
• Teamwork: We believe in teamwork and having fun together
• Career Growth: Gain great experience to promote to higher roles

Company Overview