INSURANCE APPEALS ASSOC

Overview

Insurance Appeals Associate, 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 has the responsibility of building patient accounts in the denials management system and performing timely follow-up with regard to clinical and medical necessity insurance appeals.  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.  Provides feedback to Revenue Integrity Auditors and Patient Account Representatives as it relates to department operations.

Responsibilities

• Analyze denials and coordinates insurance appeals.
• Recognizes situations which necessitate supervision and guidance, seeks appropriate resources.
• Ensures team members are compliant with front end and back end appeals hand-offs, maintaining payer correspondence and claims processing.
• Notifies Appeals Supervisor or Revenue Integrity Manager when trends are identified while processing claim denial correspondence and follow-up of appeals.
• Documents all activities in denials management and financial systems to ensure timely handoffs.
• Demonstrates the ability to understand billing regulations and payer requirements.
• Able to handle varying tasks as well as understanding patient accounting processes relative to the revenue process to ensure appropriate reimbursement is received.
• 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.

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.

Minimum Experience:

Two (2) years of experience in hospital billing or insurance pre-certification required; Must be familiar with healthcare billing and insurance regulations such as those required by Medicare, Medicaid or Commercial payers.  Computer experience is required.

Licensure Requirements: 

None.