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Medical Appeals Analyst job

Healthcare Financial Resources, LLC jobs

Company

Skills

Job Description

Essential Duties: · Review requests from Operations/Financial Analyst and review medical records to determine validity of request and approve and document medical necessity in proprietary system.· Generate Medical Appeals including, but not limited to, medical necessity, non-emergent, experimental and retro authorization.· Ensure that the requests for Medical Records from Operations/Financial Analyst are maintained within 7 business days.· Track, file, and communicate trends.· Maintain and log established information from incoming requests for appeals on the Medical Records log.· Properly file/store away the documents for pending written appeals.· Conduct general appeal research and filing as needed.· Maintains all documentation associated with the processing and handling of appeals to comply with regulatory standards and timeframes.· Meet appeal filing deadlines by completing assigned work tasks in a timely matter.· Keep all patient health information (HIPAA) and other proprietary information confidential.· Communicate with diplomacy and professionalism with all levels of employees in the organization.· Must apply knowledge of billing terms, denials, and documents to determine how best to resolve customer service issues.· Must notify upper management upon learning of any unauthorized disclosure or inappropriate use of confidential information (HIPAA).· Return packets to the supervisors when additional appeal information is needed.· Send emails to the appropriate personnel when timely filing is becoming an issue.· Properly document in proprietary system.· The employer reserves the right to assign other duties. Requirements:· Knowledge of carrier clinical policy bulletins.· Educational background or professional experience working with claim processing, third party reimbursement, and / or contractual issues.· Knowledge of how to operate basic computer functions.· Proficiency in MS Office applications (Excel, Word & Outlook) is required.· Proficiency in reading, writing and arithmetic in order to investigate claims issues, appeal denied claims, and understand how to apply contract rates.· Must demonstrate strong verbal and written communication skills.· Must have strong analytical and troubleshooting skills.· Must be a team member.· Ability to handle multiple tasks at once.· Ability to work efficiently, in an organized fashion, and meet daily and monthly department performance goals.· Must possess good customer service skills. Education/Experience:· College Degree or in process of obtaining a degree through the course of employment.· Certified Registered Nurse (RN) or minimum of 2 years of relevant studies as a Registered Nurse (RN) and professional experience working with claim processing, third party reimbursement and / or contractual issues.

TASKS

  • Protect the security of medical records to ensure that confidentiality is maintained.
  • Review records for completeness, accuracy, and compliance with regulations.
  • Retrieve patient medical records for physicians, technicians, or other medical personnel.
  • Assign the patient to diagnosis-related groups (DRGs), using appropriate computer software.

SKILLS

  • Reading ComprehensionUnderstanding written sentences and paragraphs in work related documents.

KNOWLEDGE

  • ClericalKnowledge of administrative and clerical procedures and systems such as word processing, managing files and records, stenography and transcription, designing forms, and other office procedures and terminology.
  • Computers and ElectronicsKnowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
  • English LanguageKnowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.

Healthcare Financial Resources, LLC

Type

Company - Private

Revenue

$1M to $5M

Location

Multiple locations

Industry

Healthcare

Closed Job Filters

Claims AnalystHealthcare Financial Resources, LLCElgin, IL
PURPOSE The purpose of an HFRI Claims Representative is to analyze, investigate and resolve unpaid claims for our clients. They do this through extensive verbal and written contact with InsuranceRead more
Medical Appeals AnalystHealthcare Financial Resources, LLCChicago, IL
Essential Duties: Review requests from Operations/Financial Analyst and review medical records to determine validity of request and approve and document medical necessity in proprietary system.Read more
Medical Appeals AnalystHealthcare Financial Resources, LLCCook County, IL
Essential Duties: · Review requests from Operations/Financial Analyst and review medical records to determine validity of request and approve and document medical necessity in proprietary system.·Read more
Claims Analyst.Healthcare Financial Resources, LLCChicago, IL
PURPOSE. The purpose of an HFRI Claims Analyst is to analyze, investigate and resolve unpaid claims for our clients.They do this through extensive verbal and written contact with Insurance carriers.Read more
Claims AnalystHealthcare Financial Resources, LLCCook County, IL
PURPOSE The purpose of an HFRI Claims Analyst is to analyze, investigate and resolve unpaid claims for our clients. They do this through extensive verbal and written contact with Insurance carriers.Read more
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