Revenue Cycle Denials And Appeals Specialist - TEKsystems

Description:

Job Summary:

The Revenue Cycle Denials and Appeals Specialist will be responsible for building and maintaining collaborative and productive relationships within the organization relating to Revenue Cycle Management, managing revenue cycle projects, driving performance in operations related to reimbursement and providing direction and oversight of processes impacting cash collections.

Job Responsibilities:

* Serves as a source of knowledge for the designated revenue cycle function, with a focus on Denials and Appeals

* Performs analysis, identifies trends, presents opportunity areas, and prioritizes initiatives for performance improvement for the designated revenue cycle function.

* Responsible for developing appropriate workflows and tracking for the designated revenue cycle function.

* Establishes an ongoing working relationship with other departments impacting revenue cycle performance.

* Works closely with various vendor operations teams (Prior authorization, Coding and Billing) to oversee operations activity that directly impacts the revenue cycle to accurately process actions in a timely manner for optimal reimbursement.

* Tracks outcomes of payment resolution, appeals, and negotiated claims to ensure goals are met.

* Leads weekly meetings to review key metrics, workflows, trends, and performance improvement opportunities.

* By continually reviewing and monitoring billing and coding changes, researches, evaluates, and interprets guidance from a variety of sources to determine departmental actions.

* Coordinates with Management to ensure thorough understanding of trends/issues affecting revenue cycle performance.

* Develops goals and metrics to link department and revenue cycle initiatives with the organization's strategy.

* Develops, manages and monitors successful completion of implementation and project plans.

* Acts as an educator on performance improvement requirements in operations and methodologies to related teams and departments.

* Continuously seeks new and creative technologies that help identify and guide improvement opportunities that align with overall company success.

Skills:

Medical billing, Accounts receivable, Claim, Health care, Collection, Insurance, Medical claim, revenue cycle, medicare, insurance verification, accounts payable, denied claims, appeals, revenue cycle management, medical terminology, medical billing and coding, insurance follow up, payment posting, medicaid, claims resolution, medical collections, eligibility verification, benefits investigation, claims processing, medical insurance, prior authorization, laboratory, clinical, explanation of benefits, EOBs, health insurance, provider claims, medical claims processing, health insurance claims, cpc, claims analysis, Medical, payer relations, payment poster, epic, reimbursement, outlook

Top Skills Details:

Medical billing,Accounts receivable,Claim,Health care,Collection,Insurance,Medical claim,revenue cycle,medicare,insurance verification,accounts payable,denied claims,appeals,revenue cycle management,medical terminology,medical billing and coding,insuranc

Additional Skills & Qualifications:

BVA:

* Best candidate will have lab billing/denials experience.

* Best candidates may have Medicaid and Medicare Advantage experience.

* Certified coders are a plus

* Experience handling external third party appeal review (Highest level of appeal)

* Healthcare related field of study or equivalent experience.

* NOT looking for a candidate that came from working at an insurance company. If they have worked directly at one of the large payers/insurance companies (Cigna, Aetna, etc.) as a biller they must be a rockstar on the appeals/denials side and have all the soft skills and a strong initiative to come into this role as Natera is very fast paced and a different type of mindset needed. Manager on our call said that Natera is 'FAST and FURIOUS' and they are currently working to create their infrastructure and operating rhythms together.

Experience Level:

Expert Level

send resume' to kvanduren @teksystems.com

About TEKsystems:

We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.