• Assist the Denials Prevention Manager with analyzing and reporting trends regarding billing practices both within and outside the organization.• Assists with external billing audit communications.• Assist the Denials Prevention Manager in identifying opportunities for operational improvement based on audit findings.• Performs research, gathers financial data, and conducts focused billing audits to analyze and summarize potential external audit vulnerabilities.• Provides… Show more • Assist the Denials Prevention Manager with analyzing and reporting trends regarding billing practices both within and outside the organization.• Assists with external billing audit communications.• Assist the Denials Prevention Manager in identifying opportunities for operational improvement based on audit findings.• Performs research, gathers financial data, and conducts focused billing audits to analyze and summarize potential external audit vulnerabilities.• Provides oversight for the appeals process.• Follows compliance with all laws, regulations, and guidelines of federal and state programs with an emphasis on prevention of fraud, waste, and abuse.• Prevents payor recoupment by managing audits in Craneware Insight• Follow up on Pre/Post Payment Audits which include RAC, MAC, CERT, Higher Weighted DRG and Short Stay Reviews, Payment Accuracy, and Comprehensive Hospital Inpatient and Outpatient Reviews.• Assign audit findings to appropriate team member for review/appeals process. • Insure timely appeals submission. Show less

• Serve as Lead which duties include, assist Hard Denial Specialist Team, research payer denials related to referral, pre-authorization, medical necessity, and non-covered services resulting in denials and delays in payment. Initiate appeals with insurers appropriately.• Serve as a resource for hospital Case Management and other outpatient hospital departments regarding concurrent denials.• Identify denial patterns and escalate to management departments with detailed and sufficient… Show more • Serve as Lead which duties include, assist Hard Denial Specialist Team, research payer denials related to referral, pre-authorization, medical necessity, and non-covered services resulting in denials and delays in payment. Initiate appeals with insurers appropriately.• Serve as a resource for hospital Case Management and other outpatient hospital departments regarding concurrent denials.• Identify denial patterns and escalate to management departments with detailed and sufficient information for additional follow-up, prevention, and education. • Participate in Peer Interviews and make recommendations regarding hiring new staff.• Training and onboarding new hires. Show less

• Assists ED Case Managers and House Supervisors in Bed Placement for all Inpatient, Observation and Direct admissions.• Notifies Physicians and Nursing stations as to admission of patients.• Ensure all fields of pertinent information are completed and accurate in Pre-Admissions which includes but not limited to correct insurance verification and MSPQ forms.• Work as a liaison with MedCall to insure timely transfer of patients.• Provide appropriate communication to Surgery, the… Show more • Assists ED Case Managers and House Supervisors in Bed Placement for all Inpatient, Observation and Direct admissions.• Notifies Physicians and Nursing stations as to admission of patients.• Ensure all fields of pertinent information are completed and accurate in Pre-Admissions which includes but not limited to correct insurance verification and MSPQ forms.• Work as a liaison with MedCall to insure timely transfer of patients.• Provide appropriate communication to Surgery, the Cath Lab and other areas to schedule appropriate patient placement to ensure an excellent patient care experience.• Demonstrate experience in multiple hospital systems which include Invision, Soarian, DataArk and Epic. Show less