INSURANCE APPEALS SENIOR

Overview

Insurance Appeals Senior, Revenue Integrity and Utilization

Full Time, 80 Hours Per Pay Period, Day Shift

Covenant Health Overview:

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community-owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year. Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times. 

Position Summary: 

This position provides leadership, direction, and training for the financial services staff with regard to clinical and medical necessity insurance denials. Analyzes all correspondence regarding insurance denials for the revenue integrity auditor to take appropriate action. Prepares necessary documentation for insurance appeals process, ensuring timely follow through. Processes claim adjustments for leadership approval and posts payments as necessary. Maintains integrity of denials management database for accurate statistical and educational reporting. Assists in training of staff and external vendors as it relates to department operations. Serves as a liaison between Revenue Integrity and Financial Services departments.

Recruiter: Suzie McGuinn - apply@covhlth.com

Responsibilities

• Develops and maintains departmental policies and procedures, implementing new policies and procedures relative to financial services and appeals processing.
• Analyzes denials and coordinates insurance appeals.
• Provides assistance to auditors and support staff as it relates to front end and back end appeals hand-offs, payer correspondence, and claims processing.
• Participates in the education and training of new staff as it relates to front end appeals, follow-up procedures, and hand-offs.
• Monitors for trends as it relates to payer denial activity and reports any payer non-compliance with contracting terms, provider regulations, or grievance procedures.
• Documents all activities in denials management and financial systems to ensure timely handoffs.
• Identifies and reviews problem accounts to determine reason(s) for and resolution of complex issues with little or no supervision.
• Assists the reconciliation and recovery team to resolve payment, denial, and contractual issues.
• Communicates effectively with patients/public, co-workers, physicians, facilities, agencies and/or their offices and other facility personnel using verbal, nonverbal, and written communication skills.
• Follows policies, procedures, and safety standards. Completes required education assignments annually. Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
• Performs other duties as assigned.

Qualifications

Minimum Education: 

None specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED. Preference may be given to individuals possessing a Bachelor’s degree in a directly-related field from an accredited college or university.

Minimum Experience:

Three (3) years of experience in hospital billing or insurance pre-certification required.

Licensure Requirements: 

None.