Overview
Full-time, day shift position focused on revenue integrity and denial resolution within a healthcare network.
Position Summary
Performs complex professional analysis related to the root cause and resolution of denials for corrective action. Works on revenue cycle projects related to charging, coding, documentation, and billing. Operates with significant latitude for initiative and independent judgment.
Responsibilities
- Review ADR logs, denial management reports, and payer websites to identify denials and related issues.
- Analyze claims, charging, coding, modifiers, and billing processes to recover denied reimbursement when appropriate.
- Validate that appeal steps follow contractual and regulatory guidelines.
- Prepare and package appeals submissions for ALJ, Independent Review, and Binding Arbitration.
- Coordinate with payers, leadership, physician advisors, attorneys, and internal departments to resolve denial and payment issues.
- Document denial activity, report statistics, and maintain payor issue lists.
- Support process improvement, vendor reconciliation, and special projects.
- Follow policies, procedures, safety standards, and quality improvement initiatives.
Requirements & Qualifications
Qualifications
- Associate's or bachelor's degree in HIM, Coding, Finance, Business, or Healthcare.
- At least 3 years of healthcare experience.
- Strong working knowledge of healthcare billing, Medicare/Medicaid billing guidelines, and third-party payer rules and regulations.
- Experience in problem solving and analytical reviews.
- Proficiency with PC applications, Windows, Excel, and word processing software.
- Strong public relations and communication skills.
- Preferred: Tennessee certification in one of the approved credentials such as RHIT, RHIA, CCS, CPC, or CPMA.
Location
Tennessee, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
3 weeks ago