Revenue Recovery Appeal Assistant

Full-time position, 40 hours per week, Monday through Friday.

Responsibilities

• Update financial and audit tracking systems with the financial outcomes for all government and non-government payer audits.
• Reconcile financial data in billing systems (Epic, Allegra, Star, Cerner, IDX).
• Enter financial outcomes for each pertinent case in the audit tracking database.
• Update missing and/or incorrect fields in the audit tracking database.
• Reconcile financial and audit tracking systems when payments or denials are received.
• Communicate with the appropriate billing team to complete a Part A to Part B rebill.
• Monitor and investigate all automated RAC (RAC-A) denials as well as automated RAC denials for other governmental claims.
• Review and obtain all pertinent medical record documentation needed for responding to initial audit, discussion, and appeal requests.
• Identify automated RAC denials via Medicare remittance data or other automated processes (FISS, NGS Connex).
• Review automated RAC denials for validity and collaborate with Denial Coordinators if corrections are needed.
• Communicate automated RAC denial activity to leadership and team members.
• Update financial systems and audit tracking databases with appropriate notes.
• Prepare and submit governmental and non-governmental appeals when appropriate.
• Upload appeal documents, update the audit tracking database, and ensure appeals are submitted with adequate supporting documentation timely from the date of denial.
• Monitor claims for repayment and determine if denials should be appealed using knowledge of Medicare or other governmental payor billing requirements.
• Write governmental and non-governmental appeal letters as needed.
• Monitor FISS or other automated systems for Additional Development/Documentation Requests (ADRs) for government audits received.
• Identify prepayment/post-payment ADRs via FISS on a daily basis, create regulatory audits, and upload ADRs into the audit tracking database.
• Update the ADR spreadsheet on the Shared G: Drive for all prepayment regulatory audits received via FISS.
• Monitor FISS for prepayment audit denials and review Medicare remittance, FISS, and other automated systems daily for prepayment/post-payment audit denials.
• Identify corresponding denial reason codes and remarks, upload FISS MAPs as needed, and process denials in the audit tracking database.
• Update auditor decisions, enter notes, and process cases through the workflow in the audit tracking database.
• Monitor all governmental and non-governmental audit denials and provide information as needed in an accurate and time-sensitive manner to support the appeals process.
• Review Medicare remittance data and FISS daily for RAC, MAC, and CERT denials.
• Process cases identified on the RAC Recovery Report emails received daily.
• Communicate RAC, MAC, and CERT denial activity daily to Regulatory Integrity management.
• Ensure financial and audit tracking database documentation clearly indicates the nature and outcome of denials.
• Run and analyze reports in the audit tracking database.
• Perform other duties as needed, such as faxing, scanning, emailing, printing, copying, creating cases in the audit tracking database, maintaining a daily productivity log, contacting auditors, training associates, and complying with remote work policies.

Requirements

• High School Graduate or equivalent.
• Typically requires 3 years of experience in hospital/physician coding, revenue cycle, payer contracting, billing/collections, or database management.

Skills

• Electronic Health Record and revenue cycle systems.
• Hospital and Physician Group revenue cycle operations and systems.
• Demonstrated knowledge of the regulatory audit process.
• Effective written and verbal communication skills.
• Ability to work well within a team atmosphere.
• Self-motivation.
• Knowledge of hospital reimbursement, hospital managed care contracts, and government payer reimbursement regulations.
• Experience using hospital clinical systems and Microsoft applications.
• Knowledge of hospital coding: HCPCS, CPT, Revenue Codes, DRGs; experience with hospital charge description masters (CDMs).
• Ability to operate scanner/copier and fax.

Pay

$25.30 - $37.95 per hour.

Benefits

• Comprehensive suite of Total Rewards including benefits and well-being programs, competitive compensation, and generous retirement offerings.
• Base compensation within the listed pay range based on qualifications, skills, relevant experience, and/or training.
• Premium pay such as shift and on-call pay based on the teammate's job.
• Incentive pay for select positions.
• Opportunity for annual increases based on performance.
• Paid Time Off programs.
• Health and welfare benefits including medical, dental, vision, life, short- and long-term disability.
• Flexible Spending Accounts for eligible health care and dependent care expenses.
• Family benefits such as adoption assistance and paid parental leave.
• Defined contribution retirement plans with employer match and other financial wellness programs.
• Educational Assistance Program.

About the Organization

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia, and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience, and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health serves nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics, and rehabilitation, as well as organ transplants, burn treatments, and specialized musculoskeletal programs. Advocate Health 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 equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.