Appeals-Billing Specialist | Patient Financial Services, Full-Time

Job Details

We are looking for a Appeals-Billing Specialist to join our collaborative team at Memorial Health!

About the Role

Join a team dedicated to providing exceptional healthcare services. This role involves managing appeals and billing for various programs including Sexual Assault Forensic Examination (SANE) and Medicare Short Stay.

Responsibilities

• Understands payer requirements per hospital contracts and payer policies, ensuring adherence to all payer requirements.
• Knowledge of payer contracts specific to timely filing deadlines and retro-authorization timelines.
• Collaborates with various departments throughout the organization to confirm all necessary information for the appeal is accurate and supported through medical documentation.
• Collaborate with Billing Representatives to ensure appeals and/or additional documentation is provided timely for reimbursement, collecting data and creating appeal based on payer requirements.
• Reviews denial type, payor authorization approval information documented on the account, confirms timely claim submission as required by the payer.
• Maintains claims appeal logs, tracking to ensure payor reimbursement based on payor contract terms and payer specific rules.
• Enters complete and appropriate account documentation in Health Information System (HIS) identifying all actions taken for all accounts.
• Keeps updated on all payer contract updates and provider bulletins pertaining to various appeal processes.
• Reviews Epic workqueue Appeals Communication for denied claims requiring an appeal.
• Formulates appeal letters, assembles appropriate medical records, and other pertinent information necessary to complete the appeal process.
• Understands all tools necessary to process payor specific information; Real-Time Eligibility (RTE), MyAbility-Insurance Discovery, MyCGS, and so forth.
• Knowledge of Current Procedure Terminology (CPT) and ICD-10 Diagnosis Codes.
• Contacts guarantor and/or payor in the event clarification is needed.
• Serves as a liaison between Patient Financial Services and Emergency Department SANE coordinator to ensure billing is accurate and appropriate for claims submission to the Ohio State Attorney General’s Office.
• Prepare all documentation for SANE claim submission.
• Manage and prepare all accounts for Medicare Short Stay claim billing through the various stages of the billing process in accordance with CMS billing guidelines.
• Track all Short Stay billing accounts, ensuring each step is accurate and timely.
• Manage all retro authorizations when the Current Proceduring Terminology (CPT) code on the claim does not match the code that was authorized with the payor; work queue Precert CPT not on Code Integration.

Requirements

• 1 - 3 years of hospital billing & claim appeals and hospital reimbursement experience preferred;
• Associate or bachelor’s degree preferred.
• Knowledge of revenue cycle functions, registration experience, understanding of health insurance and government programs, billing processes, managed care contracts, coordination of benefits with ability to interpret explanation of benefits desired.
• Knowledge of hospital third party billing requirements, Current Procedural Terminology (CPT), International Classification of Disease (ICD)-9, ICD-10 and modifiers.
• Knowledge of office practices and procedures, medical terminology, and the ability to communicate effectively.
• Must be proficient with Microsoft Word, Excel, and PowerPoint.

Benefits

• Medical Insurance
• Dental Insurance
• Vision Insurance
• Life Insurance
• Flexible Spending Account
• Time Off: Vacation, Sick Leave, 11 Paid Holidays, Personal Day
• Retirement: Ohio Public Employee Retirement System
• Deferred Compensation
• Tuition Reimbursement
• Kidzlink Daycare Center
• Employee Recognition
• Free Parking
• Wellness Center
• Competitive Salaries
• Community/Family Atmosphere

Location

Approx. 25 minutes away from Dublin, OH
Approx. 30 minutes away from Hillard, OH
Approx. 30 minutes away from Delaware, OH
Approx. 30 minutes away from Powell, OH

Contact Us

If you have any questions or need accommodations, please contact Memorial Health Human Resources at 937.578.2701.