INSURANCE APPEALS ASSOC

Covenant Health; Knoxville (TN); On-site; USD 40,000 - 60,000; Full time

Job summary

Covenant Health is seeking an Insurance Appeals Associate for their Knoxville, TN location. In this full-time role, you will analyze insurance denials and coordinate appeals to ensure timely reimbursement.

The ideal candidate will have two years of experience in hospital billing and a strong understanding of healthcare billing regulations. Effective communication skills are essential for this position, along with the ability to work collaboratively within the team.

Qualifications

• Requires two years of experience in hospital billing or insurance pre-certification.
• Familiarity with Medicare, Medicaid, or commercial payer regulations is necessary.
• Computer experience required.

Responsibilities

• Analyze denials and coordinates insurance appeals.
• Ensure team compliance with claims processing.
• Notify supervisors of processing trends.
• Document activities in financial systems.
• Communicate effectively with various stakeholders.

Skills

Insurance appeals analysis

Communication skills

Billing regulations knowledge

Healthcare billing familiarity

Education

High school diploma or GED equivalent

Job description

Overview

Insurance Appeals Associate, Revenue Integrity and Utilization

Full Time, 80 Hours Per Pay Period, Day Shift

Knoxville, TN

Position Summary:

This position has the responsibility of building patient accounts in the denials management system and performing timely follow-up with regard to clinical and medical necessity insurance appeals. Analyzes all correspondence regarding insurance denials for the Revenue Integrity Auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim adjustments for leadership approval and posts payments as necessary. Maintains integrity of denials management database for accurate statistical and educational reporting. Provides feedback to Revenue Integrity Auditors and Patient Account Representatives as it relates to department operations.

Responsibilities

• Analyze denials and coordinates insurance appeals.
• Recognizes situations which necessitate supervision and guidance, seeks appropriate resources.
• Ensures team members are compliant with front end and back end appeals hand-offs, maintaining payer correspondence and claims processing.
• Notifies Appeals Supervisor or Revenue Integrity Manager when trends are identified while processing claim denial correspondence and follow-up of appeals.
• Documents all activities in denials management and financial systems to ensure timely handoffs.
• Demonstrates the ability to understand billing regulations and payer requirements.
• Able to handle varying tasks as well as understanding patient accounting processes relative to the revenue process to ensure appropriate reimbursement is received.
• Communicates effectively with patients/public, co-workers, physicians, facilities, agencies and/or their offices and other facility personnel using verbal, nonverbal, and written communication skills.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.

Qualifications

Minimum Education:

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED.

Minimum Experience:

Two (2) years of experience in hospital billing or insurance pre-certification required; Must be familiar with healthcare billing and insurance regulations such as those required by Medicare, Medicaid or Commercial payers. Computer experience is required.

Licensure Requirements:

None.