Job id : 7323-5426
Restoring hope and freedom through rehabilitation.
DIVERSITY, EQUITY AND INCLUSION:
Mary Free Bed values diversity and inclusion among patients, families and staff. We strive to hire people who reflect the communities we serve. Our employees will serve all patients, families and each other with dignity and respect.
Responsible for performing analysis to identify denials, appeals and correction actions to optimize reimbursement. Analyst will leverage the interpretation of payer contracts as well as state and federal regulatory guidelines. These efforts will result in increased net revenues by reducing bad debt from potential write-offs due to lack of patient collections and denials.
* FOCUS ON PATIENT CARE. A selfless drive to serve and heal connects all MFB employees.
* CLINICAL VARIETY AND CHALLENGE. An inter-disciplinary approach and a top team of professionals create ever-changing opportunities and activities.
* FAMILY CULTURE. We offer the stability of a large organization while nurturing the family/team atmosphere of a small organization.
* TRUST IN EACH OTHER. Each employee knows that his/her co-workers can be trusted to make the right decision for our family, patients, staff and community.
* A PROUD TRADITION. Years of dedicated, quality service to our patients and community have yielded a reputation that fills our employees with pride.
ESSENTIAL JOB RESPONSIBILITIES include, but are not limited to, the following.
* Reviews explanation of benefits and benefits coverage to determine the best course of action. If needed for further clarification, contact insurance carrier
* Analyzes denial trends for staff/organizational education purposes
* Research online medical bulletins and policies, pricing and contractual issues
* Reviews clinical documentation, coding and claim to determine if the times and services provided to patients were applied correctly
* Prepares and mails written rationale of claim reconsideration request
* Tracks all denials within a database for reporting
* Maintains appropriate established timelines for follow up on outstanding appeal/reconsideration requests
* Collaborates with other Revenue Cycle Management and clinical departments to resolve claim issues as needed
* Any other duties as assigned
ESSENTIAL JOB QUALIFICATIONS (KNOWLEDGE, EDUCATION, AND TRAINING REQUIREMENTS)
* Associates Degree and a minimum of 3 years' experience in healthcare denial prevention. Knowledge of payer benefit policies and utilization review experience.
* Possesses a high level of initiative, self-directed, highly motivated and analytically minded
* Comprehension of healthcare terminology
* Time management skills to handle multiple, competing demands and priorities, and work effectively under pressure
* Strong, effective organization and interpersonal skills
* Superior written communication skills, including ability to write well organized, concise payer appeals
* Collaborative team style and open communication, including with other departments
* Excellent analysis and problem solving skills
* Demonstrated commitment to organizational mission with a \\"whatever it takes\\" attitude to get the job done
* Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)
* Excellent computer knowledge and use of appropriate Electronic Medical Records, Admissions, and Utilization Management applications
* Physical Demands: Able to exert up to 10 pounds of force occasionally (up to 1/3 of the time); able to lift, carry, push, pull, up to 10 pounds occasionally; able to sit for the majority of the time, but may involve brief periods of time walking or standing; able to use keyboard frequently (1/3 to 2/3 of the time)
OTHER PREFERRED JOB QUALIFICATIONS
* IRF medical billing experience
* Knowledge of ICD-9-CM and CPT coding classification systems
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.
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