Job description

Description: About Us:
Advent Health Partners was founded in 2010 as a provider advocate, recovering inappropriately denied third-party payer claims. Advent’s analytics and experienced staff provided insight into additional revenue to capture through clinical claim denials when appealing these claims. In fact, in 2013, our team of registered nurses, credentialed coders, and business analysts developed a technology to boost our internal processes and help productivity gain efficiency. Shortly after we implemented this technology into our practices, our productivity and agility sky-rocketed 500%. We excavated through vast amounts of disparate data silos and turned them into actionable information. CAVO®, Latin for dig, was born.
Summary
Advent Health Partners is currently looking for a Healthcare Claims Analyst with 3-5 years prior experience with post-service technical and clinically denied claims. This role does not include working billing system edits and corrections. It is more focused on clinical denials requiring detailed appeals based on review of physician documentation to determine necessity of service. This role works with both inpatient and outpatient claims.
Duties and Expectations:

• Ensures legal compliance by following guidelines, account contract, and the company's business plan
• Post-bill denial review
• Maintains quality service by following corporate customer service practices and protocols
• Analyze claims to determine the validity of denial/recovery options
• Draft detailed & convincing correspondence to effectuate reimbursement
• Contacting insurance carriers, patients, attorneys, and employers to facilitate reimbursement
• Contract analysis experience
• Conduct legal and/or scientific research when necessary to build a strong argument
• Research/Review clinical policies, contracts, and other media to aid in claims recovery.
• Be able to identify root cause issues and trends from client inventories and formulate recovery resolution
• Clearly and concisely document all actions taken to the resolution of each claim within a claims recovery system

Requirements:

• Possession of a High School Diploma or GED
• At least 3-5 years of experience within the healthcare market
• Prior experience reviewing hospital-based clinical/technical post-service denials
• Must possess the ability to determine denials from remittance / explanation of benefits, trend root cause, and take appropriate steps for resolution
• Ability to craft detailed appeal letters and contacting insurance payers for resolution
• Inpatient/outpatient claims experience strongly preferred
• Experience with payer appeal guidelines and timeframes
• Current knowledge of UB04s and Claim Adjustment Reason Codes (CARC) and Reason Adjustment Reason Codes (RARC)
• Intermediate level of Excel knowledge
• Experience with researching insurance payer policies
• Ability to resolve claims by a composing a compelling appeal letter; guiding resolution of non-routine claims; auditing claims with decision with a high overturn rate.
• Prior experience utilizing multiple EMRs (Cerner, Epic, etc.) and patient financial systems
• Thought leader with critical eye for detail
• Strong ability to effectively multi-task in a fast-paced environment
• Superior verbal, written, customer service, and analytical skills with resolution
• A continuous drive to maintain up to date healthcare industry policies and regulations
• Understanding of medical terminology used in all provider/carrier documentation
• Familiarity with working with EMR and Patient Financial related software support systems, EPIC and Cerner experience a plus
• Previous experience within a revenue cycle company strongly preferred
• Self-motivated and be able to work independently or within a team structure

Job Type: Full-time

Pay: $18.00 - $25.00 per hour

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