Revenue Recovery Appeals Assistant

Advocate Aurora Health; Winston-Salem (NC); On-site; USD 60,000 - 90,000; Full time

Job summary

Advocate Health is seeking a detail‑oriented specialist to support governmental and non‑governmental audit processes. The role involves updating audit tracking databases, reconciling financial data across billing systems, and coordinating with denial coordinators to resolve issues.

You will monitor RAC and other government claim denials, gather required medical records, and prepare timely appeals with complete documentation. Strong knowledge of EHR systems and reimbursement rules is essential.

Qualifications

• Experience with hospital/physician coding, revenue cycle, payer contracting, billing/collections.
• Knowledge of regulatory audit processes and government payors.
• Strong written and verbal communication skills.
• Proficiency with electronic health records and revenue cycle systems.

Responsibilities

• Update financial and audit tracking systems with outcomes for payer audits.
• Reconcile data in billing systems and audit tracking databases.
• Monitor RAC denials and obtain documentation for responses.
• Identify automated denials via Medicare remittance data and FISS; coordinate with denial coordinators.
• Prepare and submit governmental & non-governmental appeals with supporting documents.
• Monitor ADRs in FISS for prepayment/postpayment audits and upload ADRs.
• Review Medicare remittance data and FISS for denials; document and process accordingly.
• Maintain documentation to reflect denial outcomes and communicate to leadership.

Skills

Audit tracking

Revenue cycle

Regulatory knowledge

Communication

Teamwork

Excel

EHR systems

Coding knowledge

Education

High school diploma

Job description

Major Responsibilities

• Update financial and audit tracking systems with the financial outcomes for all government and non-government payer audits that are captured. Reconcile financial data in billing systems (Epic, Allegra, Star, Cerner, IDX), Enter financial outcomes for each pertinent case in the audit tracking database, Update missing and/or incorrect fields in the audit tracking database.
• Reconcile financial and audit tracking systems when payments or denials are received, Communicate to appropriate billing team to complete a Part A to Part B rebill.
• Monitor and investigate all automated RAC (RAC-A) denials as well as automated RAC denials for other governmental claims. Review and obtain all pertinent medical record documentation needed for responding for initial audit, Discussion, and Appeal requests.
• Identify automated RAC denials via Medicare remittance data or other automated process (FISS), NGS Connex. Review automated RAC denial for validity. Collaborate with Denial Coordinators and if denial needs to be corrected. Communicate automated RAC denial activity to leadership and team members,
• Responsible for updating the financial systems and all other pertinent systems such as the audit tracking database with appropriate notes.
• Prepare and submit Governmental & Non-Governmental appeals when appropriate, Upload appeal documents, update audit tracking database, and financial systems. Ensure appeals are submitted with adequate supporting documentation and that the appeal is sent timely from date of denial. Submit appeal and monitor claim for repayment. Using knowledge of Medicare (or other governmental payors) billing requirements, determine if denial should be appealed. Determine the reason for denial on specific claims. Update financial and audit tracking database, Responsible for writing Governmental & Non-Governmental appeal letters as needed.
• Monitor FISS or other automated system(s) for Additional Development/Documentation Requests (ADRs) for Government audits received. Identify Prepayment/Post Payment Additional Development Requests via FISS on a daily basis. Create regulatory audits, and upload ADR(s) that are received in audit tracking database. Update ADR spreadsheet on Shared G: Drive for all prepayment regulatory audits received via FISS
• Monitor FISS for prepayment audit denials, On a daily basis review all Medicare remittance, FISS, and other automated system(s) for prepayment/Post Payment audit denials, Identify the corresponding denial reason code and remarks. Upload FISS MAPs as needed to process denials into the audit tracking database. Update the auditor decision, enter note, and process through the workflow in the audit tracking database.
• Monitor all Governmental & Non-Governmental audit denials. Provide information as needed in an accurate and time sensitive manner to support the appeals process. On a daily basis review all Medicare remittance data and FISS for RAC, MAC, and CERT denials. Process cases identified on the RAC Recovery Report emails that are received on a daily basis. Communicate RAC, MAC, and CERT denial activity on a daily basis to Regulatory Integrity management. Responsible that the financial and all other pertinent systems such as the audit tracking database documentation clearly indicate the nature and outcome of the denial. Run and analyze reports in audit tracking database.
• Performance of other duties as needed when appropriate. Fax, scan, email, print, copy. Create cases in the audit tracking database. Keep daily productivity log up to date. Contact Governmental & Non-Governmental auditors and contractors. Train new and/or existing associates.

Education Requirements

• High School Graduate or equivalent

Experience Requirements

• Typically requires 3 years of experience in hospital/physician coding, revenue cycle, payer contracting, billing/collections, database management.

Knowledge, Skills & Abilities Required

• Electronic Health Record and revenue cycle systems
• Hospital and Physician Group revenue cycle operations and systems
• Demonstrated knowledge of regulatory audit process
• Effective written and verbal communications skills.
• Ability to work well within a team atmosphere.
• Self-motivation
• Knowledge of hospital reimbursement, hospital managed care contracts; government payer reimbursement regulations
• Knowledge and experience using Hospital clinical systems and Microsoft applications
• Knowledge of Hospital coding: HCPCS, CPT, Revenue Codes, DRGs; experience with hospital charge description masters (CDMs)
• Ability to operate scanner/copier, fax
• Must comply with AAH Remote work policy

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.