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Hours Full-time, Part-time
Location Atlanta, GA
Atlanta, Georgia

About this job

Responsible for the appeal of technical denials to achieve optimal financial outcomes. Performs retro reviews of denials and submits formal technical appeals to payers per department policy. . Documents appeal information.. Report trends and payer inconsistencies. Measures and monitor payer responses in order to support process improvement. Monitors and reports to managed care denials manager and business office on patterns of denials and outcomes of appeals. Performs follow up on denials and tracks outcomes. Refers medical necessity, level of care, appropriate patient type and clinical OP denials to physician consultant in coordination with clinical denials specialist. Work collaboratively with physician offices, Patient Access, Utilization Review, HIM and facility clinicians to correct deficiencies in a timely manner. Prioritizes assignments to avoid financial risk. Serves as a financial resource to team. Stays current with payer regulations, appeals processes and industry trends. Utilizes reports to categorize denials and underpayments for trending purposes. Identifies and pursues opportunities for improvement in denial performance Holds payers accountable to the negotiated contract terms. Negotiates with non- contracted 3rd party administrators for maximum reimbursement.

MINIMUM QUALIFICATIONS: Graduate of an accredited college, Bachelors degree preferred. Combination of education and experience may considered in lieu of degree. HFMA Certified Patient Account Representative required, Advance CPAR preferred. 3 years hospital business office experience to include collections, 3re party billing, contract interpretation, and technical appeals. Strong verbal and written communication skills. Should be proficient in Microsoft Office with heavy exposure to patient accounting software and applications. Must be familiar with ICD 10 coding methodology, payer and regulatory policies, medical terminology, and payment and adjustment calculations. Work collaboratively with physician offices, Patient Access, Utilization Review, HIM and facility clinicians to correct deficiencies in a timely manner. Demonstration of conflict resolution and mediation skills. Decision making, problem solving skills, critical thinking and listening skills required. Must be able to adapt to competitive ever changing work environment.

PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.

ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.