Top 4 Appeals audit specialist Jobs in Flint, Mi

Appeals Audit Specialist
McLaren Health Care —Grand Blanc, MI
- Full-time
- Surgery
- 5 years
- Mid-level
- On-the-job training
MEDICAL BILLING SPECIALIST
HAMILTON COMMUNITY HEALTH NETWORK —Flint, MI
- Full-time
- Ability to walk for extended periods
- Word processing
- Computer literacy
Quick Apply
Quality & Accreditation Specialist, Michigan
McLaren Health Care —Flint, MI
- Full-time
- Surgery
- Mid-level
- Home Health
- Health insurance

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Appeals Audit Specialist

McLaren Health Care -
Grand Blanc, MI

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Job Details

Full-time

Benefits

On-the-job training
Leadership training provided

Qualifications

Optimizing workflow processes
Appeals
Committee work
Completing CE credits
Process audits
5 years
Overseeing healthcare denial management
Medical coding guidelines
Mid-level
RHIT
Certified Professional Coder
Case appeal in utilization management
Continuous improvement
Certified Coding Specialist
Quality improvement
Compliance documentation
Medical denial root cause analysis (RCA)
Medical record retrieval
Medical billing account reconciliation
LPN
Claims documentation management
Associate's degree
Insurance claims appeal handling
Healthcare coding investigations
Process management
Leadership
Transaction reconciliation
Audit support
Documentation reviews

Full Job Description

Position Summary:

Responsible for timely and accurate processing, follow-up, and appeal of audits and denial activity received from payers and/or auditors. Provides support to both internal and external customers for denial/appeals activities and audits. Assists with monitoring and auditing activities, reviews outcomes and communicates findings as appropriate. Collaborates with ICM departments/staff, as well as external departments in support of timely issue resolution, process improvement initiatives, and response to inquiries to payer denials.

Essential Functions and Responsibilities as Assigned:

Supports activities consistent with Integrated Care Management Denials across all MHC subsidiaries.

Accountable for achieving care management outcomes and fulfills the obligation and responsibilities of the role to support the clinical team.

Collaborates with the Denials Appeals RN to ensure payer appeal/filing deadlines are met and achieve optimal payment for services rendered.

Ability to write appeals demonstrating accuracy/proficiency in referencing support from the medical record documentation and coding guidelines with timely and successful submissions.

Assists in identifying denial trends and selecting the most appropriate method for resolution.

Provides support in response, tracking and completion of all payer audit/denial/appeal activity to ensure that timelines in the process are met, including requests for medical record documentation and the filing of responses and appeals.
- Appropriately documents denial/appeal activities; oversees and documents payer and third-party payer contractors (including federal and state payer) activities.
- Monitors and suggests modifications to workflows to maintain effective, timely and efficient processes.
- Assists with reconciliation process to verify accuracy and completeness of payers’ take-backs and rebilling based upon denial/appeal findings and maintains documentation of such activity.
- Provides recommendations for improvements, based on denial/appeal results and assist in implementing action plans. Assists subsidiaries with tracking, reporting, and developing action plans, as necessary.
- Assists in performance of follow-up reviews to assess adequacy of implemented action plans.
- Logs, tracks, refers and closes appeals timely.

Participates in the revenue cycle process (Central Business Services – CBS) to ensure both compliance and the maximization of appropriate reimbursement on denied/appealed cases based on medical record documentation and coding guidelines.

Participates on assigned designated corporate and subsidiary committees, to evaluate denial/appeal outcomes improvement

Attends continuing education sessions to maintain competency and knowledge of regulations in denials, utilization management, care management, clinical documentation, and leadership skills and participates in ongoing leadership training offered by ACMA.

Performs other related duties as required and directed.

Qualifications:

Required:

Registered Health Information Technician (RHIT), Licensed Practical Nurse (LPN), hospital biller, or associate degree.
5 years’ health care experience

Preferred:

Bachelor’s degree in healthcare related field
ACMA or ACDIS memberships
Certified Medical Coder, Certified in Healthcare Compliance, Certified Coding Specialist, or Certified Clinical Documentation Specialist certifications

Additional Information

Schedule: Full-time
Requisition ID: 26003639
Daily Work Times: 8am - 4:30pm
Hours Per Pay Period: 80
On Call: No
Weekends: No

About Us

McLaren Health Care, headquartered in Grand Blanc, Michigan, is a $7.3 billion, fully integrated health care delivery system committed to quality, evidence-based patient care and cost efficiency. The McLaren system includes 12 hospitals in Michigan, ambulatory surgery centers, imaging centers, a 640-member employed primary and specialty care physician network, commercial and Medicaid HMOs covering more than 732,838 lives in Michigan and Indiana, home health, infusion and hospice providers, pharmacy services, a clinical laboratory network and a wholly owned medical malpractice insurance company. McLaren operates Michigan’s largest network of cancer centers and providers, anchored by the Karmanos Cancer Institute, a National Cancer Institute-designated comprehensive cancer centers. McLaren has 20,000 full-, part-time and contracted employees and more than 113,000 network providers throughout Michigan, Indiana and Ohio.

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appeals audit specialist jobs in flint, mi

Appeals Audit Specialist

MEDICAL BILLING SPECIALIST

Quality & Accreditation Specialist, Michigan

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