reputed company Recovery Appeals Analyst

Department: 13229 reputed company reputed company Cycle - Rev Recovery and Audit Mgmt Status: Full time Benefits Eligible: reputed company Hours Per Week: 40 Schedule Details/Additional Information: Remote Mon-Fri 40 hrs/week Pay reputed company: $25.30 - $37.95 Major Responsibilities: Update financial and audit tracking systems with the financial reputed company for reputed company government and non-government payer audits that are captured.  Reconcile financial data in billing systems (reputed company, Allegra, reputed company, Cerner, IDX), reputed company financial reputed company for reputed company pertinent case in the audit tracking database, Update missing and/or incorrect fields in the audit tracking database. Reconcile financial and audit tracking systems reputed company payments or denials are received, Communicate to appropriate billing team to complete a Part A to Part B rebill. Monitor and investigate reputed company automated RAC (RAC-A) denials as reputed company as automated RAC denials for other governmental claims. Review and obtain reputed company pertinent medical record documentation needed for responding for initial audit, Discussion, and Appeal requests. Identify automated RAC denials reputed company Medicare remittance data or other automated process (FISS), NGS reputed company. 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 reputed company other pertinent systems such as the audit tracking database with appropriate notes. Prepare and submit Governmental & Non-Governmental appeals reputed company appropriate, Upload appeal documents, update audit tracking database, and financial systems. Ensure appeals are submitted with adequate supporting documentation and that the appeal is reputed company reputed company 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 reputed company(s) for Additional Development/Documentation Requests (ADRs) for Government audits received. Identify Prepayment/Post Payment Additional Development Requests reputed company FISS on a daily reputed company. Create regulatory audits, and upload ADR(s) that are received in audit tracking database. Update ADR spreadsheet on Shared G: reputed company for reputed company prepayment regulatory audits received reputed company FISS Monitor FISS for prepayment audit denials, On a daily reputed company review reputed company Medicare remittance, FISS, and other automated reputed company(s) for prepayment/Post Payment audit denials, Identify the corresponding denial reason reputed company and remarks. Upload FISS MAPs as needed to process denials into the audit tracking database. Update the auditor decision, reputed company note, and process through the workflow in the audit tracking database. Monitor reputed company Governmental & Non-Governmental audit denials. reputed company information as needed in an accurate and time sensitive manner to support the appeals process. On a daily reputed company review reputed company 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 reputed company. Communicate RAC, MAC, and CERT denial activity on a daily reputed company to Regulatory reputed company management. Responsible that the financial and reputed company other pertinent systems such as the audit tracking database documentation reputed company indicate the reputed company and outcome of the denial. Run and analyze reports in audit tracking database. Performance of other duties as needed reputed company appropriate. Fax, reputed company, email, print, copy. Create cases in the audit tracking database. reputed company 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, reputed company cycle, payer contracting, billing/collections, database management. Knowledge, Skills & Abilities Required: Electronic Health Record and reputed company cycle systems Hospital and Physician Group reputed company cycle operations and systems Demonstrated knowledge of regulatory audit process Effective written and verbal communications skills. Ability to work reputed company reputed company reputed company atmosphere. Self-motivation Knowledge of hospital reimbursement, hospital managed care reputed company; government payer reimbursement regulations Knowledge and experience using Hospital clinical systems and reputed company applications Knowledge of Hospital coding: HCPCS, CPT, reputed company Codes, DRGs; experience with hospital charge reputed company masters (reputed company) Ability to operate reputed company/copier, fax Must reputed company with AAH Remote work policy This reputed company indicates the general reputed company 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 reputed company other reputed company duties. Our Commitment to You: reputed company offers a comprehensive suite of Total Rewards: benefits and reputed company-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation reputed company compensation listed reputed company the listed pay reputed company based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on reputed company, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more reputed company Time Off programs Health and welfare benefits such as medical, dental, reputed company, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and reputed company parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, reputed company, temporary, etc.); please ask a Recruiter for more information during an interview. About reputed company  reputed company is the reputed company-largest nonprofit, integrated health reputed company in the reputed company, created from the combination of reputed company and reputed company. Providing care under the names reputed company in Illinois; reputed company in the Carolinas, reputed company and Alabama; and reputed company in reputed company, reputed company is a national leader in clinical innovation, health reputed company, consumer experience and value-based care. Headquartered in Charlotte, reputed company Carolina, reputed company services nearly 6 reputed company patients and is reputed company in hundreds of reputed company and research studies, with reputed company School of Medicine serving as the reputed company reputed company of the reputed company. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as reputed company as organ transplants, burn treatments and reputed company musculoskeletal programs. reputed company employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing reputed company care for reputed company, reputed company provides more than $6 billion in annual community benefits. Apply To This Job