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Essential Duties and Responsibilities:

    • Differentiates between clinical and technical denials through EOB’S, denial letters/payer correspondence and data mining.
    • Identifies payer and hospital’s managed care contracts.
    • Reviews managed care contracts against application of rates, provisions and terms.
    • Reviews timely filing guidelines regarding the appeals process.
    • Contacts payer to negotiate resolution on technical denials.
    • Appeals denials using all means necessary (appeal letters, medical records and other supporting documentation, utilization of on-staff clinicians).
    • Evaluates appeal outcome for next steps (logs recovered funds, supports uphold decision or initiates 2nd level appeal).
    • Manages assigned workload of accounts through timely follow up and accurate record keeping.

Minimum Qualifications & Competencies:

    • Four-year degree preferred or equivalent experience in hospital related billing/follow-up field
    • Benefits/fund administration experience preferred
    • Knowledge of/experience working with managed care contracts
    • Experience working with customer support/client issue resolution management
    • Strong analytical acumen
    • Strong multi-tasking skills
    • Proficiency with MS Office