AR Denial Management & Appeals Specialist, 250 E. Liberty St, 8a-430p

University Medical Center, Inc.; Cincinnati (OH); Vor Ort; USD 40.000 - 70.000; Vollzeit

Zusammenfassung

UofL Health is seeking a Revenue Cycle Appeals Specialist to initiate and manage the appeal process for denied claims. You will coordinate with Clinical Appeals Specialists to overturn denials, draft substantiating letters, and track outcomes for management review.

The role requires 1-3 years of billing, collections, or appeals experience, strong medical terminology knowledge, and proficient MS Office skills to support documentation and reporting.

Qualifikationen

• Education: High School education or GED required.
• Experience: 1-3 years of prior billing, collection, or appeals.
• Knowledge, Skills, and Abilities: medical terminology, clear written communication, ability to draft professional letters.

Aufgaben

• Initiates the appeal process under Revenue Cycle management guidance until overturned or options exhausted.
• Coordinate and appeal technical denials with Clinical Appeals Specialists.
• Develop appeal letters to substantiate overturning denial (coverage, authorization, non-covered services).
• Track progress and report outcomes to Revenue Cycle leadership.
• Complete follow-up on appealed claims and communicate with insurance carriers.

Kenntnisse

Billing

Revenue Cycle

Appeals

Medical terminology

Ausbildung

High School diploma or GED

Tools

Microsoft Office

Jobbeschreibung

Primary Location

250 E Liberty St Address: 250 East Liberty St. Louisville, KY 40202 Shift: First Shift (United States of America)

Job Description Summary

UofL Health is a not-for-profit 501(c)(3) fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, more than 250 physician practice locations, and more than 1,200 providers in Louisville and the surrounding counties, including southern Indiana. With more than 14,000 team members - physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.

Job Description

Initiates the appeal process, at the direction of Revenue Cycle management, until the case is overturned, appeal options are exhausted, or decision is made to discontinue process. This position assumes the responsibility for coordinating and appealing technical denials and working closely with Clinical Appeals Specialists responsible for clinical appeals.

Essential Functions

• Ability to review and determine reason for insurance denial of claims
• Review and appeal unpaid claims daily and submit appeal timely.
• Develop appeal letters to substantiate overturning denial, i.e. coverage, authorization, non-covered services, contract issues, timely filing limit, etc.
• Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for Revenue Cycle leadership
• Completes follow-up work on appealed claims.
• Works with insurance carriers on appeal issues.
• Ensure clinical appeals are submitted to the appropriate department
• Monitoring the payments to ensure reimbursement from third-party payers is accurate based on payer contract.
• Reviews denials for accuracy.
• Stays abreast of payer updates for authorizations, eligibility, etc. and communicates to Revenue Cycle leadership
• Document all activity in designated Revenue Cycle system
• Attends continuing education programs
• Other duties as assigned

Other Functions

Maintains compliance with all company policies, procedures and standards of conduct Complies with HIPAA privacy and security requirements to maintain confidentiality at all times Performs other duties and employment requirements as assigned.

Additional Job Description

Education: High School education or GED required. Experience: 1-3 years of prior billing, collection, or appeals Job Competency: Knowledge, Skills, and Abilities critical to this role: Knowledge of medical terminology. Clear and concise written communication skills and development of professional letters. Basic Microsoft Office knowledge. Ability to foresee projects from start to finish. Additional Responsibilities: Sedentary Work: Lifting 10lbs. maximum and occasionally lifting and/or carrying items as needed. Frequent Talking (Expressing or exchanging ideas by means of the spoken word.) Frequent Hearing (Perceiving the nature of the sounds by the ear.) Frequent Seeing (Visual acuity, depth perception, field of vision, color vision). Consistent use of hand movement for keyboarding purposes. Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. With more than 14,000 team members - physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care.