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- Appeals Processing: This will have been satisfactorily completed when...
- Denials are reviewed, logged and assigned to appropriate department within 5 day of receipt of denial letter/EOB.
- A professional and grammatically correct correspondence using appropriate letter based on the type of denial is composed and a 93% accuracy rate is maintained.
- An appeals letter is submitted to private payor(s) 5 days prior to due date.
- Denial Analytics & Reporting: This will have been satisfactorily completed when...
- Data is entered accurately into denial tracking system and denial spreadsheet within 5 business days following receipt of denial.
- All denials are easily accessible, clearly categorized and organized accurately
- Monthly summaries of denials are completed by payer and dollar amount. Report submitted to manager, director and or administration by 5th of month
- On-going trend analysis is provided to identify the reason for the denial and corrective action steps are applied to protect revenue integrity by 10th of month.
- Month-to-month analysis of at risk revenue and appeals received are reported by the 10th of the month.
- Month-to-month analysis of closed appeals and appeals overturned are reported by the 10th of the month.
- Process Improvement & Compliance: This will have been satisfactorily completed when...
- The auditor reports to manager any delays, issues or denial patterns with payers on weekly basis.
- Assistance is provided to the manager for the development of department education related to denial types and trends . Will document and keep track of educational activities , participants and training contents. Reports quarterly to managers.
- Follow up analysis of effectiveness of educational activity is performed; findings are reported to manager monthly.
- Participation is conducted quarterly in at least one quality improvement activity.
- Other Duties As Assigned: This will have been satisfactorily completed when...
- Assistanice is provided to the revenue cycle and business office functions at month end or year end as requested by manager or director.
- Other duties as assigned are completed.
- EXPERIENCE: 5 yrs acute care hospital billing/claims adjudication.
- EDUCATION: High School or equivalent. Bachelors Degree substitutes for 4 yrs exp.
- SPECIAL SKILLS: Excellent oral & written communication skills