10341 Enterprise Revenue Cycle - Revenue Recovery Audit
Full time
Yes
40
Schedule Details/Additional Information:
Monday through Friday 8:00am to 5:00pm
This is a REMOTE Opportuni
Pay Range
$40.30 - $60.45
Major Responsibilities:
- Responsible for training, evaluating and staffing coverage for Revenue Recovery.
- Performs quality review process audits and staff feedback. Ensures acceptable productivity levels and assigned tasks/appeals are completed
- Identify process inefficiencies and opportunities for daily workflow improvement and participate in developing new processes with Revenue Recovery Manager.
- Keeps abreast of current standards, regulations, and issues related to denials and Revenue Recovery including but not limited to, Government and Insurance Payer reimbursement regulations, clinical practices, utilization management, process improvement and health care industry trends via literature, educational offerings, federal register, etc.
- Maintains an effective working relationship with both internal and external customers.
- Act as a resource for new payer requirements. Participate in monthly Payer meetings, gathers data and reports issues/discrepancies
- Monitors and manage daily reports to ensure timely appeals per payer requirements.
- Investigate and respond to questions from other departments, physicians, payers, and patient related to insurance denials.
- Perform clinical denial review and appeals as needed based on coverage needed. Ensure personal and staff productivity goals are met or exceeded.
- Performs human resources responsibilities for staff which includes coaching on performance, completes performance reviews and overall staff morale. Recommends hiring, compensation changes, promotions, corrective action decisions, and terminations.
- Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to the organization's business.
Licensure:
Education/Experience Required:
- Bachelor's degree in Nursing
Knowledge, Skills & Abilities Required:
- Solid knowledge of third-party health care insurance plans, denials and appeals procedures.
- Solid knowledge of utilization/denial management and managed care.
- Knowledge of CMS and other regulatory requirements.
- Understanding of process improvement.
- Demonstrated flexibility, teamwork, and system thinking.
- Proven understanding and analyzing patient bills and medical records.
- Knowledge of government and nongovernment clinical denial and appeal procedures
- Excellent relationship building skills.
- Excellent written and verbal skills.
Physical Requirements and Working Conditions:
- This position requires travel, therefore, will be exposed to weather and road conditions.
- Operates all equipment necessary to perform the job.
- Exposed to a normal office environment.
Our Commitment to You:
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation
- Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
- Premium pay such as shift, on call, and more based on a teammate's job
- Incentive pay for select positions
- Opportunity for annual increases based on performance
Benefits and more
- Paid Time Off programs
- Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
- Flexible Spending Accounts for eligible health care and dependent care expenses
- Family benefits such as adoption assistance and paid parental leave
- Defined contribution retirement plans with employer match and other financial wellness programs
- Educational Assistance Program
About Advocate Health
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.