Job description

DUTIES AND RESPONSIBILITIES:

• Completes payer related probe and provider specific pre and post payment review activities.
• Ensures all medical record requests are responded to in a timely manner.
• Ensures all possible efforts are made to obtain appropriate internal and external medical record documentation to support the services provided and billed.
• Tracks medical documentation received and compiled, completes medical reviews, sends outbound requests, and ensures all necessary information are obtained (where it exists).
• Maintains, improves, or develops customer / client relationship throughout related medical record request communications.
• Trends, tracks and reports on related activity and results.
• Ensures related appeals are completed timely, appropriately, and related results tracked and trended with modifications / improvements made where appropriate.
• Follows related policies and procedures and escalates where appropriate.
• Completes medical review related customer chart documentation trend analysis for outreach training and education opportunities.
• Ensures all medical record requests are responded to in a timely manner
• Ensures all reasonable efforts are made to obtain appropriate external medical record documentation to support the services in question.
• Ensures medical record documentation received is recorded appropriately and ensures management of outbound documentation requests.
• Maintains, improves, or develops internal and external customer / client relationship throughout related medical record request communications.
• Trends, tracks and reports on related activity and results.
• Works with internal and external customers as needed to develop a plan for improved results.
• Follows related policies and procedures and escalates where appropriate.
• Provides support and analysis on reimbursement integrity matters and works collaboratively to troubleshoot and problem solving on complex assignments.
• Perform research, reviews, and assessments of broad compliance issues and specific internal audit engagements and government requests.
• Coordinates resolution of escalated reimbursement challenges and related billing matters. Completes any special projects as needed and requested by department leadership.
• Ensures all deliverables are of appropriate quality level, and success measures are met or exceeded.
• Conducts post‐project evaluations and assessment of results as requested.
• Assists with the development, maintenance and execution of related policies and procedures.
• Assists with training and the support of department staff.
• Supports staff and department leadership with development of needed/required knowledge base.
• Responds to verbal and written inquiries within policy and procedure timeline. Research accounts and documents follow up appropriately.
• Resolve account discrepancies and prepare adjustments and refunds for approvals as necessary.
• Maintain accurate and complete records concerning activity on all accounts.
• Assists in standardization of goal setting of productivity and performance monitoring.
• Researches and makes recommendations for revenue cycle improvements.
• Perform other tasks as assigned to support the goals of the organization.

Benefits:

• Medical/Rx
• Dental
• Vision
• Healthcare FSA
• Dependent Care FSA
• Basic Life and AD&D
• Voluntary Life and AD&D
• Voluntary Disability
• Additional Voluntary Benefits
• Voluntary Universal Life with Chronic Condition Rider
• Employee Assistance Program (EAP)
• same day advances are available, discussed at interview

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to stand; to handle or feel; to talk and to hear. The employee is occasionally required to walk, sit, reach with hands and arms and stoop, kneel, crouch or crawl. The employee must occasionally lift and or move up to 15 pounds. Specific vision abilities required by this job include close vision, depth perception and ability to adjust focus.

REQUIREMENTS

• Bachelor’s degree preferred.
• 2-5+ years relevant experience required
• MUST BE COVID VACCINNATED
• Ability to manage multiple projects.
• Proven ability to think strategically and implement tactically.
• Strong interpersonal, negotiation and communication skills (verbal and written).
• Excellent written, verbal, and interpersonal communication skills.
• Strong organizational and analytical skills. Exceptional attention to detail.
• Team player who is able to prioritize, work well under pressure, readily adapt to change, and excel in a productivity-based environment.
• Demonstrated research and problem-solving skills.
• Excel, healthcare background, auditing, CMS and appeals experience preferred

Job Types: Full-time, Temporary

Pay: $20.00 - $32.00 per hour

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday
• Weekend availability

Experience:

• relevant: 4 years (Preferred)

License/Certification:

• Bachelor’s degree (Preferred)
• MUST BE COVID VACCINNATED (Preferred)
• Ability to manage multiple projects. (Preferred)
• Excel, healthcare background, auditing, CMS and appeals (Preferred)
• Excellent written, verbal, interpersonal skills. (Preferred)

Work Location: In person

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