Essential Duties and Responsibilities

•  Complete monthly denial logs in required timeframe
• Attend monthly denial meetings with facilities as assigned
• Communicate with all necessary departments to identify and resolve denial trends and issues
• Review and analyze all denial trends and issues as assigned
• Maintain working knowledge of all payer guidelines and requirements as they relate to denials and appeals.
• Monitor and work all denials and appeals as assigned
• Properly track and document all denial and appeal activity.
• Maintain all logs, account notes and system records as assigned
• Review outpatient RAC denials and appeal as needed
• Monitor AB rebills that needed on RAC accounts and post recovery or denial adjustments as needed
• Monitor assigned duties in C360, and ensure proper handling of all RAC accounts

QualificationsTo perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed
below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Education and Experience

• High school diploma or equivalent
• Minimum of one year experience in a healthcare setting

Preferred

• Working knowledge of the revenue cycle

Required Knowledge/Abilities

• Working knowledge of denials and appeal processes including a basic understanding of contracts and payer policies
• Working knowledge of current medical terminology
• Ability to communicate effectively both verbal and written
• Ability to work independently and to meet deadlines

Required Computer Skills:

• Working knowledge of Outlook, Microsoft Word and Excel or equivalent