Responsible for researching and resolving claim denials, ADR requests and certs, submitting and tracking appeals, noting trends and providing monthly reports. Responds to audit requests (including RAC) from payors. Maintains a Library of Payer reference material regarding requirement for pre authorization, medical necessity and documentation requirements. Works with the Revenue Cycle stakeholders (e.g. Admitting, Coding, Provider Liaisons, etc.) to provide information related to denials and opportunities for future denials.

Education:
Required: High School diploma or equivalent
Preferred: Associate degree

Licensure/Certification:
Preferred: Certified coder or currently enrolled in a coding program

Experience:
Required: Minimum of two years of Professional Billing with an emphasis in Managed Care denial follow up and appeals processing Prior hospital billing experience a plus.
Preferred: three to five years of Patient Accounting in a high volume environment.

Specific Skills, Knowledge, Abilities Required:
Strong Analytical skills, Proficient in Microsoft Windows with emphasis on Excel.
Ability to prioritize and coordinate workflow and attention to detail.
Knowledge of CPT, HCPC and ICD 10 coding requirements with emphasis on modifiers and diagnosis association.
Working knowledge of LCD’s, NCCI and MUE edits as well as a general knowledge of Commercial, HMO, and Medicare Advantage claims, authorization and documentation requirements.

Job Type: Contract

Pay: $24.44 - $27.43 per hour

Expected hours: 40 per week

Schedule:

• 8 hour shift
• Day shift

Work setting:

• In-person

Ability to Relocate:

• Rancho Mirage, CA 92270: Relocate before starting work (Required)

Work Location: In person