Insurance Appeals Senior
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Job Location:
Knoxville, TN - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
Overview
Insurance Appeals Senior Revenue Integrity and Utilization
Full Time 80 Hours Per Pay Period Day Shift
Covenant Health Overview:
Covenant Health is the regions top-performing healthcare network with 10hospitalsoutpatient and specialtyservicesandCovenant Medical Group our areas fastest-growing physician practice division. Headquartered in Knoxville Covenant Health is a community-owned integrated healthcare delivery system and the areas largest employer. Our more than 11000 employees volunteers and 1500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes Best Employer seven times.
Position Summary:
This position provides leadership direction and training for the financial services staff with regard to clinical and medical necessity insurance denials. Analyzes all correspondence regarding insurance denials for the revenue integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process ensuring timely follow through. Processes claim adjustments for leadership approval and posts payments as necessary. Maintains integrity of denials management database for accurate statistical and educational reporting. Assists in training of staff and external vendors as it relates to department operations. Serves as a liaison between Revenue Integrity and Financial Services departments.
Recruiter: Suzie McGuinn -
Responsibilities
- Develops and maintains departmental policies and procedures implementing new policies and procedures relative to financial services and appeals processing.
- Analyzes denials and coordinates insurance appeals.
- Provides assistance to auditors and support staff as it relates to front end and back end appeals hand-offs payer correspondence and claims processing.
- Participates in the education and training of new staff as it relates to front end appeals follow-up procedures and hand-offs.
- Monitors for trends as it relates to payer denial activity and reports any payer non-compliance with contracting terms provider regulations or grievance procedures.
- Documents all activities in denials management and financial systems to ensure timely handoffs.
- Identifies and reviews problem accounts to determine reason(s) for and resolution of complex issues with little or no supervision.
- Assists the reconciliation and recovery team to resolve payment denial and contractual issues.
- Communicates effectively with patients/public co-workers physicians facilities agencies and/or their offices and other facility personnel using verbal nonverbal and written communication skills.
- Follows policies procedures and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
- Performs other duties as assigned.
Qualifications
Minimum Education:
None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge skill and ability needed to perform the essential tasks of the job typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a Bachelors degree in a directly-related field from an accredited college or university.
Minimum Experience:
Three (3) years of experience in hospital billing or insurance pre-certification required.
Licensure Requirements:
None.
Key Skills
- Sales Experience
- Time Management
- Marketing
- Customer Service
- Communication skills
- Retail Sales
- Business Management
- Outside Sales
- Telemarketing
- Insurance Sales
- Medicare
- Phone Etiquette
About Company
Covenant Health is the top-performing healthcare network in East Tennessee. Our experienced staff is ready to support your medical needs.
