Bayhealth Medical Center
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Recovery Analyst - Care Management
at Bayhealth Medical Center
Full time 80 (Two week Payperiod)
Pay Grade 60 (Minimum hourly rate $13.46/hr)
8:00 AM to 4:30 PM
Serve as the gatekeeper for all denial and appeal activities on inpatient claims for Commercial, Managed Care, and Medicare payers. Responsible for the logging, processing, and tracking of Third Party Payers (TPP) denials and appeals. Conduct data collection for analysis in order to determine appropriate appeal process. Provide communication of denial and clinical information to either the attending physicians or the Physician Advisor for their determination to pursue a physician to physician appeal review. Coordinate physician to physician calls as needed. Identify and work independently with the Denial & Appeal Team (DAA) and TPPs to resolve less complex denials. In collaboration with the Care Management Office Operations Manager and DAA Team, work with Care Managers, physicians, Patient Access, Health Information Management (HIM), and Patient Finance (PFS) to compile necessary documentation to support appeals for more complex denials. Provide assistance to CM Management for denial prevention interventions and reconciliation with Insurers, Finance, DAA, and CM staff.
Minimum Education and Experience:
High School Diploma or GED
Associate degree in Business or Accounting
2 years' experience with medical billing. collections, or insurance authorizations
2 years' experience in Patient Finance or Patient Access
Prior experience with appeal processing with Third Party Payors
Proficient in Word, Excel, or similar software
Experience in flow charting
Experience in use of clinical data entry systems.
Health Information Tech
Special Knowledge, Skills, and/or Abilities:
· Keyboarding 35 wpm
· Adept at problem solving
· Possess critical thinking skills
· Ability to prioritize multiple tasks
· Ability to work with minimal supervision
· Medical terminology
· Proficient in reading, writing, and speaking English.