This position supports key aspects of the revenue cycle to include the claim appeals process and denial follow-up. The Accounts Review Specialist serves as the point of contact and liaison between the payer and medical group for the appeals process for Vidant Medical Group for all payers. An effective accounts review specialist will identify denials eligible for the claim appeals process, improve collections, and work with team members to develop edits and processes to reduce denial rate.
Work with Revenue Cycle manager to develop a Claim Appeals department to review denials and recover revenue related to denials.
Identify claims that can and cannot be appealed.
Knowledge of and implementation of the five levels of the appeals process (Redetermination, reconsideration, administrative law judge hearing, departmental appeals board/Medicare appeals council review, Federal Court Review), time limits, and reconsiderations, etc.
Work with Revenue Cycle manager to identify, develop, and coordinate the implementation of edits in HealthSpan to help mitigate denial rate.
Review consistent denials for possible edit implementation to ensure claims are billed/coded correctly prior to claim release.
Designate specific denials that will be designated to fall into a claim appeals work queue.
Serves as the point of contact and liaison between the payer and Vidant Medical Group for the appeals process for all payers.
Initiates and maintains dialogue with payers in reference to disputed claims, maintains adequate documentation of on going efforts for disputed claims.
Provides report of claim appeals and outcomes. Discusses pending/denied claims appeals as needed with management and appropriate staff.
Responsible for reviewing and initiating claim appeals process for claim denials sent by CBO for possible claim appeals.
Ensure claims are held/deferred for appropriate length of time for completion of appeals process.
Responsible for developing and implementing processes that will minimize denials and reduce days in AR.
Stays abreast of the current rules and regulations for all payers and any changes in the claim appeals process.
Reviews most current Medicare, Medicaid & BCBS bulletins.
Accesses Provider on Line Services and Blue E for updates.
Responsible for educating management and staff regarding billing rules and regulations.
Minimum Position Requirements
High School plus 2 years of formal education/training. Certified Coder (CPC)
Professional billing experience, provider based-billing, rural health clinic billing experience preferred.
1 - 3 years experience in claims processing, Professional billing experience, provider based-billing, coding experience, rural health clinic billing experience preferred.
1 full - time vacancy.
It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.
Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.
Vidant Health is an Equal Opportunity Employer. EOE/AA Applications for Vidant Health and its subsidiary corporate entities are accepted and employees are chosen for employment without regard to race, color, gender, religion, age, national origin, marital status, citizenship, veteran status, or disability.
Vidant Medical Center - 15 months ago