RCO Appeals Specialist

Job Description:

The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Responsible to proactively identify insurance denial trends and to then work with Payer Contracting on these issues.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, and Washington.

Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings

Essential Functions

• Understands and uses various contracts and laws (i.e., ERISA, self-funded, State and Federal insurance) to appropriately appeal medical claims that have been denied.

• Conducts and refers patient accounts when requested by payers, audit firms, patient and RCO departments to determine the appropriateness of billed charges, chargemaster data, revenue cycle data and UB/HCFA1500 information that is on the claim.

• Interpret and accurately identify the true reason of the denial and review payer contracts, clinical data and other data to be able to appeal in a correct and concise way.

• Assesses the appropriateness of clinical appeal requests by working with and using evidence- based utilization review criteria, payer policies and Federal and State regulations.

• Refers appeal cases to the designated Physician Advisor and works with them to obtain support for appeals.

• Collaborates with Care Management, Physician Advisors, Revenue Integrity, Compliance, legal counsel, and RSC teams to prepare appeals.

• Identifies trends and opportunities for denial prevention and collaborates with the appropriate multidisciplinary teams to improve denial management, documentation, and appeals process.

• Supports legal counsel to prepare for Administrative Law Judge hearings as part of the appeal process.

• Serves as a subject matter expert, resource and mentor to others within the RCO, clinical departments, Appeal RN's, legal, IPAS and Payor Contracting on the art of appealing.

Skills

• Medical billing

• Interpersonal skills

• Communication

• Healthcare Regulations

• Insurance regulations

• Medical terminology

• Critical thinking

• Problem solving

• Patient advocate

• Collaboration

Physical Requirements:

Qualifications

Required

• Demonstrated experience in a healthcare revenue cycle role

• Demonstrated proficiency in computer skills including Microsoft Office, internet and email

• Demonstrated experience in a role utilizing exceptional written communication skills

• Demonstrates knowledge of State/Federal/ERISA and self-funded insurance laws

Preferred

• Demonstrated experience in healthcare insurance billing, follow-up, denials and appeals or audit role.

• Bachelor's degree preferred.

• Experience with Epic preferred.

Physical Requirements

• Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.

• Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.

• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

• May have the same physical requirements as those of clinical or patient care jobs, when the leader takes clinical shifts.

• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Lake Park Building

Work City:

West Valley City

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$21.84 - $33.23

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits package here (https://intermountainhealthcare.org/careers/benefits) .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.