HIM Appeals Specialist
Company: UofL Physicians
Posted on: March 28, 2020
This position is responsible for successfully managing all
components of post-discharge denials as well as payer and RAC
audits. Actively involved in CDMP and work closely with Coding
Managers on DRG appeals. Interacts as needed with internal
customers to include but not limited to hospital staff, physicians
and their offices, and other revenue cycle team members. Actively
participates in department and hospital performance initiatives
when needed to ensure ULH success.
- Log appeals correspondence into Appeals Tracking software.
- Review denials for accuracy, prepare appeal letters, and
perform timely follow-up on all unpaid claims for HIM-related
denials (i.e., post-discharge medical necessity, DRG validations,
retroactive prior authorizations, RACs, and other claim
- Ensure all timelines are met for additional records requests
- Obtains all necessary information to expedite the appeal
- Works with payers on HIM-related appeal issues.
- Maintain overall financial viability for UMC Revenue Cycle
through collaboration and effective communication with Care
Management, Physicians, Coding, and Patient Financial
- Perform quantitative and qualitative reviews prior to reporting
data trends and outcomes.
- Prepare reports on post-discharge denials management activity
including overturn success rate of appeals for corporate
- Attend continuing education workshops, webinars, etc., for
- Perform other duties as assigned.
- High School education or GED required.
- Must have and maintain one of the following nationally accepted
Certified Coding or Nursing Credentials (I.e., RHIT, RHIA, CPC,
CPC-H, CCA, CCS, NRCCS, CCS-P, LPN or RN).
- 3 years of prior in-inpatient coding or clinical nursing
- Prior experience working with government and commercial payers,
a plus.KNOWLEDGE, SKILLS, & ABILITIES
- Knowledge of medical terminology.
- Demonstrate excellent organizational, computer, written and
oral communication skills.
- Demonstrate strong Microsoft Office knowledge skills.
- Must possess working knowledge of InterQual, Milliman Care
Guidelines, and Coding Rules and Guidelines.
- Strong time management and critical thinking skills. Ability to
foresee projects from start to finish as well as identify trends in
denials management data.
Keywords: UofL Physicians, Louisville , HIM Appeals Specialist, Other , Louisville, Kentucky
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