Appeals Analyst- HIM, Full-Time, Woodbury

Position Description The Health Information Management (HIM) Appeals Analyst position will have administrative oversight related to denial appeal management within the HIM Department. Responsibilities include managing, processing, and tracking work related to denials and appeals that are processed through the HIM Department. The HIM analyst will actively manage, organize, maintain and communicate denial/appeal activity to appropriate stakeholders and ensure appeal due dates are met and will work closely with HIM and appeals team. The HIM analyst will be responsible for complete, timely, and accurate daily maintenance and updates to the denials management system and generate weekly, monthly reports to leadership, including escalation of key issues to management as needed. The HIM analyst will collaborate with HIM team and members from various departments including; Information Systems, clinical providers, vendors, Business Services, Revenue Integrity, and other areas as needed. •3 5 years experience of medical claims experience within a healthcare setting required. •Strong knowledge of ICD-10, CPT, and HCPCS codes, Uniform Hospital Discharge Data set (UHDDS), health insurance plans and medical billing practices, and billing reimbursement preferred. •Strong healthcare background, with knowledge of denials and appeals process and HIM management of medical records required. •Excellent computer skills required with proficiency in all MS Office applications; Excel, Word, and Power Point, with excellent skills using Adobe and other similar software for use in all denial appeal activity where needed. •Experience with Cerner, Soarian and a Computer Assisted Coding program preferred. •Proficient in use of payer websites/portals preferred. •Excellent organizational skills with strong communication skills and ability to manage multiple project tasks, timelines and meet due dates. •Ability to analyze complex medical information and make informed decisions regarding claim denials. •Understanding of different health insurance plans, including Medicare and commercial policies preferred. Education: Associate degree in Health Information Technology, healthcare administration, or a related field required, Bachelors degree preferred. In lieu of degree, 4-5 years of direct experience in the field required. Certification/Licensure: Certified Coding Specialist or RHIT certification preferred. Physical Requirements Place an N, O, F or C in the boxes below N: Never O: Occasionally (0%) F: Frequently (20%-80%) C: Constantly 80%) Lifting 0lbs O Standing F Sitting C Lifting 20-50lbs O Climbing O Kneeling O Lifting50lbs O Crouching O Reaching O Carrying F Hearing C Walking F Pushing O Talking O Vision C Environmental Conditions Noise F Varied Temperatures O Cleaning Agents O Noxious odors O Patient Exposure O Operative Equipment O Position Responsibilities •Receives and analyzes electronic and mail denial letters. Also logs, scans, and submits denials and appeals to the appropriate payer to meet due dates. •Works with coders, billers, providers and vendors to ensure denials are appealed timely. •Submits appeals with all required medical records and documents in accordance with payer requirements in response to the denial specifications including but not limited to submitting appeal letter and tracking results in the denial management system. •Prints and submits medical records requested from the payer by mailing, faxing or portal submission, in accordance with HIPAA guidelines. •Completes all scanning and uploading of appeals documents into the legal medical record (LMR). •Tracks appeal outcomes, identifies trends, and generates reports to identify areas for improvement. •Follows up with vendors on appeal letters to ensure due dates are met., and escalates any issues or barriers to management. •Works with the HIM manager to develop and improve workflow processes when needed to assure meeting denial appeal due dates. •Also responsible for the medical record data integrity which includes medical record amendments and patient identity, and assists in chart corrections and other patient identity data corrections as needed. Collaborates with the patient identity team to ensure Inspira Health System record maintains a correct legal medical record (LMR). •Performs all other duties as assigned. ?>