What are the responsibilities and job description for the AR Denials Management and Appeals Specialist position at UofLHealth?
Overview
WE ARE HIRING!Location: 250 E Liberty Street Louisville, KY 40202
About UofL Health: UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.uoflhealth.org.
Job Summary:
Initiates the appeal process, at the direction of Revenue Cycle management, until the case is overturned, appeal options are exhausted, or decision is made to discontinue process. This position assumes the responsibility for coordinating and appealing technical denials and working closely with the HIM Appeals Specialist responsible for clinical appeals.
Responsibilities
- Ability to review and determine reason for insurance denial of claims
- Review and appeal unpaid claims daily and submit appeal timely.
- Develop appeal letters to substantiate overturning denial, i.e. coverage, authorization, non-covered services, contract issue, timely filing limit, etc.
- Develop and maintain detail denial inventory list
- Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for Revenue Cycle leadership
- Completes follow-up work on appealed claims.
- Works with insurance carriers on appeal issues.
- Ensure clinical appeals are submitted to the HIM department
- Monitor the payments to assure reimbursement from third-party payers is accurate based on payer contract.
- Reviews denials for accuracy.
- Stays abreast of payer updates for authorizations, eligibility, etc and communicates to Revenue Cycle leadership
- Documents all activity in Revenue Cycle system.
- Attends continue education programs
- Other duties as assigned.
Qualifications
MINIMUM EDUCATION & EXPERIENCE
- High School education or GED required.
- 1-3 years of prior billing, collection, or appeals
KNOWLEDGE, SKILLS, & ABILITIES
- Knowledge of medical terminology.
- Clear and concise written communication skills and development of professional letters.
- Basic Microsoft Office knowledge.
- Ability to foresee projects from start to finish.
