University of Louisville Hospital
AR Denials Management and Appeals Specialist
University of Louisville Hospital, Louisville, Kentucky, us, 40201
OverviewWE ARE HIRING! Location:250 E Liberty Street Louisville, KY 40202
About UofL Health
UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.
Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.uoflhealth.org.
Job Summary:
Initiates the appeal process, at the direction of Revenue Cycle management, until the case is overturned, appeal options are exhausted, or decision is made to discontinue process.
This position assumes the responsibility for coordinating and appealing technical denials and working closely with the HIM Appeals Specialist responsible for clinical appeals.
Responsibilities
Ability to review and determine reason for insurance denial of claims
Review and appeal unpaid claims daily and submit appeal timely.
Develop appeal letters to substantiate overturning denial, i.e. coverage, authorization, non-covered services, contract issue, timely filing limit, etc.
Develop and maintain detail denial inventory list
Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for Revenue Cycle leadership
Completes follow-up work on appealed claims.
Works with insurance carriers on appeal issues.
Ensure clinical appeals are submitted to the HIM department
Monitor the payments to assure reimbursement from third-party payers is accurate based on payer contract.
Reviews denials for accuracy.
Stays abreast of payer updates for authorizations, eligibility, etc and communicates to Revenue Cycle leadership
Documents all activity in Revenue Cycle system.
Attends continue education programs
Other duties as assigned.
QualificationsMINIMUM EDUCATION & EXPERIENCE
High School education or GED required.
1-3 years of prior billing, collection, or appeals
KNOWLEDGE, SKILLS, & ABILITIES
Knowledge of medical terminology.
Clear and concise written communication skills and development of professional letters.
Basic Microsoft Office knowledge.
Ability to foresee projects from start to finish.
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About UofL Health
UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations, and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital.
Affiliated with the University of Louisville School of Medicine, UofL Health is committed to providing patients with access to the most advanced care available. This includes clinical trials, collaboration on research and the development of new technologies to both save and improve lives. With more than 13,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. For more information on UofL Health, go to www.uoflhealth.org.
Job Summary:
Initiates the appeal process, at the direction of Revenue Cycle management, until the case is overturned, appeal options are exhausted, or decision is made to discontinue process.
This position assumes the responsibility for coordinating and appealing technical denials and working closely with the HIM Appeals Specialist responsible for clinical appeals.
Responsibilities
Ability to review and determine reason for insurance denial of claims
Review and appeal unpaid claims daily and submit appeal timely.
Develop appeal letters to substantiate overturning denial, i.e. coverage, authorization, non-covered services, contract issue, timely filing limit, etc.
Develop and maintain detail denial inventory list
Tracks and trends progress and outcomes of denial and appeal processes and compiles reports for Revenue Cycle leadership
Completes follow-up work on appealed claims.
Works with insurance carriers on appeal issues.
Ensure clinical appeals are submitted to the HIM department
Monitor the payments to assure reimbursement from third-party payers is accurate based on payer contract.
Reviews denials for accuracy.
Stays abreast of payer updates for authorizations, eligibility, etc and communicates to Revenue Cycle leadership
Documents all activity in Revenue Cycle system.
Attends continue education programs
Other duties as assigned.
QualificationsMINIMUM EDUCATION & EXPERIENCE
High School education or GED required.
1-3 years of prior billing, collection, or appeals
KNOWLEDGE, SKILLS, & ABILITIES
Knowledge of medical terminology.
Clear and concise written communication skills and development of professional letters.
Basic Microsoft Office knowledge.
Ability to foresee projects from start to finish.
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