This site uses cookies. To find out more, see our Cookies Policy

Senior Appeals Analyst Full Time in Largo at Parallon

Date Posted: 11/29/2018

Job Snapshot

  • Employee Type:
  • Location:
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:

Job Description

Job Summary - Researches and Resolves High Dollar Technical and Top Dollar Clinical Appeals through concise understanding of Payer Contract Language and Clinical or Technical justification. Position requires individuals with high mathematical acumen, ability to access and assimilate data, articulate a strong case, confidence, and strong persuasion skill set. Results oriented individual will be required to work through various options available to liquidate the most difficult top dollar appeals. Candidate will demonstrate ability to grow strategic payer relationships and obtain understanding of payer system to navigate through the appeals process. Critical thinking skills are necessary, as well as ability to see trends that require escalation to the Payment Compliance Director. Responsible for bundling similar cases not resolved through the standard Payment Compliance process and escalate to Dispute Resolution Team for legal action.
Supervisor – Director, Clinical Appeals
Supervises - N/A
Duties (included but not limited to):
• Review technical and clinical denial arguments for reconsideration on top dollar accounts, including both written and telephonically through resolution process.
• Identify coding or clinical documentation issues and work to correct the errors in a timely manner.
• Identify contract protection that can be leveraged to overturn denials.
• Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument.
• Identify problem accounts/processes/trends and escalate as appropriate.
• Utilize effective documentation standards that support a strong historical record of actions taken on the account.
• Identifies and communicates contract interpretation issues and language discrepancies to leadership as appropriate.
• Identifies Payer company trends and communicates trends to supervisor for further action/escalation.
• Serves as a subject matter expert in payer appeals resolution process.
• Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
• Other duties as assigned

Job Requirements

• Communication - communicates clearly and concisely, verbally and in writing.
• Persistence – comfortable pursuing, rebutting and escalating issues as appropriate.
• Goal-oriented – holds him/herself accountable to achieving shared and personal goals.
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Interpersonal skills - able to work effectively with other employees, patients and external parties.
• PC skills - demonstrates high proficiency in Microsoft Office applications and others as required.
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems.
• Mathematical skills - able to perform advanced mathematical calculations and balance and reconcile figures
• Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.
• Bachelor’s degree required.
• Master’s degree preferred.
• Two years of related experience.
Requires prolonged sitting/standing, some bending, stooping, walking and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports or other information. Requires lifting
papers/boxes and pushing/pulling up to 25 pounds occasionally. Work is performed in an office environment or hospital setting. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.
MOC: 68J, 92Y, 3043, 001672, PS