Anna King Email & Phone Number

• Develops detailed knowledge of and drives the focus and goals of Utilization Review (UR)• Retrieves and disseminates clinical data to third-party payers for authorization/certification of hospital level of care for front end/concurrent and retrospective certifications• Provides orientation, direction, and ongoing mentoring/coaching of the Care Coordination Clerk • Identifies opportunities for improvement related to denial management and report outcomes to the URM at least monthly• Maintains accuracy of inpatient and outpatient working spreadsheet to include posting of payment, payment date, payor, and action performed• Works within established processes of UR to identify denied/rejected/underpaid claims• Performs interventions, appeals, and appropriate referrals to protect and collect potentially lost revenue by following up on inpatient and outpatient interventions and appeals to include calling insurance companies, physician’s offices, patients, and related DCH departments• Provides oversight for authorizations and denials• Assists UR Manager in developing strategies for overturning appeals and reversing denied claims• Applies critical thinking skills and knowledge to each claim to prioritize and perform interventions to maximize revenue protection within timely filing• Utilizes Compliance 360, MIDAS, and eFR for reports and information related to denials• Assists the URM in educating the UR team on denial prevention• Participates in annual departmental project and assists in leading the team in UR denial prevention• Assists URM to arrange team meetings and may be responsible for minutes as requested• Maintains performance, patient and employee satisfaction and financial standards• Adheres to DCH Behavioral Standards including creating positive relationships with patients/families, and colleagues • Requires use of electronic mail, time and attendance software, learning management software and Intranet

Tuscaloosa, Alabama Area

Register patient in the Meditech system to be seen by the physican and obtain copies of patient I.D. and insurance cardsVerify that the patient’s insurance is of active status through the Accureg system and determine any copays, unmet deductibles, or coinsurances the patient might oweCollect copays, unmet deductibles, and coinsurances and post the payments to the patient’s accountBalance the petty cash drawer at the end of the shift and deposit any money collected into the safeApply CPT codes to patient accounts

Associate Of Science - As, Registered Nursing/Registered Nurse

Medical Insurance Coding Specialist/Coder