PREBILL ANALYST – WORK FROM HOME
The Prebill Denials Analyst will review post discharge, prebill accounts that do not have an authorization on file, ALOS versus days authorized variances, and/or other account discrepancies identified that will result in the account being denied by the payor that do not require a clinical review.
Communicates with third party payors to resolve discrepancies prior to billing.
Accurately and concisely documents all communications and action taken on the account in accordance with policies and procedures.
The Prebill Denials Analyst will escalate medical review request and/or denial activities to the Prebill Denials Nurse.
This is a full-time work from home opportunity
Verification of authorization on services post discharge, prebill
Validating re-certification for additional days post discharge, prebill
eRequest queues as determined during program implementation
Duties (included but not limited to):
Work prebill accounts identified via the Meditech reports efficiently and effectively on a daily basis to resolve accounts with no auth numbers and ALOS vs. authorized days variances
Work assigned accounts in eRequest to resolve outstanding issues
Report insurance denial trends identified during daily operational assignments
Identify problem accounts and escalate as appropriate
Document actions taken on the account clearly and concisely
Contacting the facilities, physicians’ offices and/or insurance companies to resolve denials/appeals
Adhere to time and attendance policies
Adhere to all policies and procedures, including phone and internet usage, break utilization, etc.
Participate in ongoing education and training as needed
Establish and maintain relationships with all customers
Seeks assistance from immediate supervisor when in situations which are unclear or ambiguous
Adheres to established policy and procedure and escalates issues through the established Chain of Command
Demonstrates commitment to teamwork and cooperation
Practice and adhere to the Code of Conduct philosophy and Mission and Value Statement
Other duties as assigned
Knowledge, Skills & Abilities
Customer Orientation establishes and maintains long term customer relationships, building trust and respect by consistently meeting and exceeding expectations
Communication – communicates professionally, clearly and concisely
Interpersonal skills ability to establish and maintain collaborative and effective working relationships
PC Skills demonstrates advanced proficiency in Microsoft Office applications and others data mining software
Policies & Procedures – demonstrates knowledge and understanding of organizational policies, procedures and systems
Basic skills demonstrates ability to organize, perform and track multiple tasks accurately in short timeframes and have ability to work quickly and accurately in a fast-paced environment while managing multiple demands
Revenue Cycle operational experience in the following areas: appeals, denials, managed care,
Verifications/notification, precertification experienced preferred
Work from Home Requirements
Designated Work Area: Remote Workers are required to maintain a separate, designated work area at home
Minimum Technical Specifications: Home Internet Connectivity: Download and Upload -10Mbps
PHYSICAL DEMANDS/WORKING CONDITIONS
Requires prolonged sitting, some bending, stooping and stretching.
Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports.
Requires lifting papers or boxes up to 25 pounds occasionally.
Work is an office environment.
Work may be stressful at times.
Contact may i…
Insurance , Insurance Claims , Medical & Health , Medical Billing