Bayhealth Medical Center

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Recovery Analyst - Care Management

at Bayhealth Medical Center

Posted: 6/7/2019
Job Status: Full Time
Job Reference #: 104591

Job Description

Care Management

Full time 80 (Two week Payperiod)

Days

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:

Minimum

Preferred

Education:

High School Diploma or GED

Associate degree in Business or Accounting

Experience:

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

Computer/Software Knowledge:

Proficient in Word, Excel, or similar software

Experience in flow charting

Experience in use of clinical data entry systems.

Licensure/Certification

None required

Health Information Tech

Medical Terminology

Special Knowledge, Skills, and/or Abilities:

· Keyboarding 35 wpm

· Adept at problem solving

· Possess critical thinking skills

· Self-motivated

· Ability to prioritize multiple tasks

· Ability to work with minimal supervision

· Medical terminology

· Proficient in reading, writing, and speaking English.