Appeals Analyst Team Lead Full Time
Hughston Clinic · Columbus, Georgia, US
Position Goal : Utilize coding certification knowledge and reimbursement methodology experience to monitor compliance; analyzing and pursuing appeal opportun...
Job description
Position Goal: Utilize coding certification knowledge and reimbursement methodology experience to monitor compliance; analyzing and pursuing appeal opportunities with payers and reporting appeals performance. Perform claim audits to ensure billing compliance with coding rules and guidelines as well as payer-specific policies and conducts research initiatives to support overall billing and documentation compliance on an enterprise basis. Experience: Required: Education: Required: Preferred: - Implements processes for identifying under-allowed claims using Contract Compliance tools and other available tools. - Leverages coding knowledge to focus specifically on surgical/procedure based claims and medical necessity denials to identify appeal opportunities. - Trends surgical claim billing errors by payer, provider, etc, to identify gaps in training and develop educational materials. - Analyzes zero pay reports with special attention to surgical/procedure claims to evaluate billing accuracy regarding the correct use of ICD-10, CPT, HCPCs coding. - Verifies applicable contract by, as dictated by operational procedures: reviewing EOB messages, reviewing patient ID card, verifying member i...