Job Information
Firelands Regional Medical Center Audit and Denial Assistant: FT, Days in Sandusky, Ohio
Description
Position Highlights:
Lifestyle: Sandusky was voted “Best Coastal Small Town in America”. You will have the opportunity to enjoy living and working in this growing area along the beautiful shores of Lake Erie.
Work/life: You will find support to help you manage your personal life while building a career, flexible scheduling may be available
Employee-centric: Tuition Assistance and assistance with certification expense, loan forgiveness, comprehensive major medical, dental and vision insurance, paid time off, 401(k), health and wellness offerings, monthly employee events, and more.
About Firelands Health:
Our goal at Firelands Health is to be the best & preferred independent healthcare employer for the Sandusky Bay region.
Firelands Health is the area’s largest and most comprehensive resource for quality medical care. We are “big enough to care for you, and small enough to care about you”. We are locally managed and governed as a not-for-profit healthcare facility, serving the counties of Erie, Ottawa, Sandusky, and Huron, covering a regional service area with over 300,000 residents. Our mission is to provide excellent healthcare, promote community wellness, and improve the lives we serve.
Our Core ACE Values: Attitude: We choose to be positive and inclusive every day. Commitment: We are committed to exceed the expectations of those we serve. Enthusiasm: We will work passionately to make a difference.
What you will do:
Responsible to distribute audit requests and denial notifications timely and accurately meeting deadline requirements. Performs audit entry, denial entry, and follows up with various payors in regards to record submission and/or appeal decisions via various methods including mail, electronic portals, sFTP, esMD, fax and secure email. Completes data entry for both audits and denials into the tracking software, EMR/billing software, as well as, any other tracking or audit augmentation methods.
Accountable to streamline submission processes to electronic methods whenever possible in an effort to be fiscally responsible.
Efficient with all payor software, audit/appeal tracking software tools, electronic software, EMR and review programs utilized in the audit & appeal process. Understands CPT, HCPCs, DX & Px codes and revenue codes. Stays current with additions, deletions, revisions and updates as necessary. Works effectively within the audit & denials tracking tool along with other RAC team members to ensure up-to-date RAC and audit strategies are in place. Efficient with shared RAC drive operation. Participates in RAC team meetings.
Assists and supports with the timely medical record production to enable efficient management and formulation of appeals within determined deadlines.
Ability to categorize denial issues. Ability to understand industry and legal guidelines across the submission and appeal process, while working in conjunction with Coding, UR, Case Management, Patient Accounts, and individual departments to achieve successful appeal strategies.
Works effectively within the audit tracking software and RAC team to ensure that up-to-date RAC, TPE, SMRC and other audit & denial strategies are in place. Able to monitor and track audits, findings, denials and appeals to keep activity within set deadlines. Monitor records submissions and appeal outcomes to track and trend success.
Works with MedeAnalytics to validate that patient accounting data is accurately transferring between systems without troubleshooting as needed.
Assist with reporting out of MedeAnalytics as requested/required.
Displays positive guest relations and demonstrates service excellence in performance of duties.
Attends in-services, educational programs, required department meetings, continuing education courses to keep abreast of new developments and current industry standards.
Maintains confidentiality and discretion regarding all work matters, and fully complies with all legal and ethical obligations including applicable hospital policies.
Participates in department performance improvement activities as assigned and attends required training.
Demonstrates service excellence and ACE.
What you will need:
Must possess a high school diploma and/or higher level of education desirable.
Strong computer skills including Excel.
Strong organization skills and the ability to multi-task.
Minimum of 2 years administrative healthcare experience.
Capable of adapting to changing environment.
Knowledge of major insurance/Medicare terminology and benefits is beneficial.
Strong interpersonal skills. Ability to understand and effectively communicate in both written and oral form and handle sensitive telephone and face-to-face inquiries.
Knowledge of the Medicare program and its regulatory mandates desired.
Punctual attendance at assigned work location is required.
Ability to work in a safe and efficient manner and maintain an accident free work place, including the ability to demonstrate a working knowledge of emergency codes.
Ability to comply with OSHA regulations and CDC standard and transmission-based precaution recommendations and to utilize proper personal protective equipment.
Ability to comply with provisions of applicable S.D.S. forms.
Successful completion of a ninety (90) day probationary period.
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)