Position Highlights:

     ·Responsible for the review and appeal of administrative authorization denials. Coordinates with the appeals/denial recovery specialists for escalated reviews, as needed.

  The Ideal Candidate Will Have:

• Knowledge of third party reimbursement, charging and coding guidelines.
• Preferred - Soarian experience.

Responsibilities:

• Reviews denials and identifies root cause of denial.
• Makes primary determination whether denial might be overturned. Contacts insurance company to appeal.    
• Calculates expected reimbursement denied dollars for both contracting and non-contracting insurance companies.
• Resolves reimbursement discrepancies using knowledge of reimbursement methodologies including, but not limited to, Per-Diem, DRG, fee schedule, percentage of charges, and stop loss.
• Understands medical coding systems effecting the adjudication of claims payment. These include ICD, CPT, HCPCS, DRG, APG, APC, and revenue code structures.  

Credentials and Qualifications:

      ·Associate’s Degreein Healthcare, Finance or other required.

     ·A minimum of two (2) years related experience in health care required. *Seven (7) years of related healthcare experience may be considered in lieu of an Associate's degree.*