Remote PT, SLP, OT, or RN Appeal Writer/Reimbursement Analyst (Genesis) 105 views

Job Overview

  • Specialty License RN, SLP, PT, OT

This individual must be an PT, OT or SLP who will work remotely supporting the appeals process.

 

POSITION SUMMARY:
Assists the Genesis denial management team by conducting a comprehensive analytical review of patient’s medical records. Appeal Writer/ Reimbursement Analyst will write sound, sensible and factual arguments that clearly argue for payment of the services provided. Specific reasons for denials are to be addressed directly with justification for the services to be paid.

 

RESPONSIBILITIES/ACCOUNTABILITIES:
1. Review patient medical records; utilize clinical, regulatory knowledge and skills to provide convincing appeal arguments as to why a claim should be paid.
2. Identify and report trends in charts that are resulting in denials
3. Identify regulatory changes or trends in appeal decisions that may be in breach of published regulations or payer policy guidelines
4. Use clinical evidence and/or regulatory arguments to prove appeal reasoning.
5. Participate in Administrative Law Judge hearings by providing testimony as necessary.
6. Request additional supporting clinical evidence to support appeal arguments when existing resources are inadequate for justifying services. .
7. Proficiently read and understand abstract information from handwritten patient medical records. Review large amounts of information (medical records) and determine what is necessary to support an appeal.
8. Request late entry documentation as needed.
9. Ensure compliance with HIPPA regulations.
10. Familiar with the various Attestation templates, ability to prepare them correctly as requested.
11. Familiar with the various MAC’s and their LCD’s
12. Ability to articulate decision to appeal or waive an appeal to department lead/manager with support to validate next action.
13. As needed, facilitate communication with designated billing/business offices in support of Denials Management process.
14. Provide regulatory and payer policy guidance for appeal requests at all levels.
15. Maintain tracking records of appeals management activities in accordance with department policies
16. Performs other duties as requested.
Qualifications:
1. General understanding of Medicare, DDE system and HMO EOB’s (Denials)
2. Knowledge of the 5 Medicare Appeal Levels and HMO Appeals
3. Knowledge of basic Medicare Billing practices in a Skilled Nursing Facility
4. Knowledge of the PPS System and the various changes it has undergone in the past few years.
5. Proficiency with CMS Requirements
6. Excellent written and verbal communication skills
7. Strong analytical, organizational, follow-up and research skills
8. Extremely dependable and a self-starter.
9. Adapt quickly to changing priorities
10. Flexibility with a willingness to learn and adapt to changes in regulations and task-related priorities.
11. Ability to meet all scheduled responsibilities in a timely manner
12. Ability to work successfully with minimal supervision
13. Exceptional time management
14. Problem Solver–ability to make suggestions of documents that could assist in correcting an error once one is identified.
15. Advanced knowledge of Outlook email system

Compliance Responsibilities

 

1. Complies with applicable legal requirements, standards, policies and procedures including but not limited to those within the Compliance Process, Standard/Code of Conduct, Federal False Claims Act and HIPAA.
2. Participates in required orientation and training programs.
3. Promptly reports concerns and suspected incidences of non-compliance to supervisor, Compliance Liaison or to the Compliance Officer via the Integrity Hotline.
4. Cooperates with monitoring and audit functions and investigations.
5. Participates, as requested, in quality assurance and process improvement activities.

 

SRA2

QUALIFICATIONS:

SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS:1. Licensed Therapist (any discipline) or Registered Nurse2. Significant experience in the Healthcare Industry.3. Knowledge of regulatory requirements for reimbursement and reasons for denials.
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