R1 RCM Inc. is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices. Headquartered in Chicago, R1® is a publicly-traded organization with employees throughout the US and international locations.
Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.
Description
The Appeal Follow-up Support is responsible for the accurate and efficient loading and follow up of portal related submission and inquires and the identification of posted payments from healthcare accounting systems.
Responsibilities
* This is not an inclusive list. Other duties may be assigned
· Be able to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, Itemized Bills, Hospital Account notes, appeal letters, and denial/approval letters.
· Utilize software system to obtain work assignments and communicate with other employees in a clear and concise manner.
· Be able to identify a payment posted in a healthcare system, retractions and date of posting.
· Maintain an understanding of how to utilize a multitude of hospital patient accounting systems (i.e.; Epic, Meditech, Eagle, and Paragon) to accurately identify payments and retractions.
· Print and review a high volume of payment histories per day; approximately 500.
· Work closely with staff responsible for all aspects of payment verification to ensure all provider systems are trolled in accordance with the weekly trolling schedule.
· Be proficient in common notation practices within the healthcare system. This includes, but is not limited to payments, adjustments, retractions, billings, notes, etc.
· Post received payments in software system and appropriate spreadsheets for accurate billing of clients.
· Navigate through payer portals to submit appeals, documentation and inquiries to the plan.
· Timely follow up on the status of all submissions via the portal.
· Notify the appropriate staff on the status of portal submissions.
· Submit responses to insurers via the portal.
· Utilize provider systems to obtain necessary documentation for case files based on requests from employees.
· Resolve, call, inquire and/or appeal a defined number of accounts per day as instructed leadership.
· Draft appeals and letters to insurance companies.
· Make proper notations in software system on all accounts.
· Understand and utilize payer contracts and provider manuals when disputing denials.
· Use proper approved note structure when notating all accounts.
o Insurance company name @ number dialed | First name and last initial of the representative spoken to. (Ex. Aetna @ 1-800-624-0756 | John S.)
· Follow up on all appeals, claims, letters or other documentation within 20 days or less of the submission.
· Follow up on all payments at the time an overturn letter is received.
· Demonstrate an understanding of office workflow by completing necessary required fields correctly.
· Ensure that assigned accounts are appealed timely through the use of an internal worklist.
· Maintain worklist through daily audits and the open task report.
· Ensure that all assigned cases have a follow up and that there are no duplicate follow ups.
· Address all follow ups promptly.
o Alerts must be addressed within a day of receipt.
o Initial call requests must be addressed within two days from the receipt of the follow up.
o Follow ups should never be more than 14 days old.
· Handle RUSH cases appropriately.
o A RUSH is any appeal or submission that is due within two weeks from the date the due date was verified.
· Maintain one follow up in each assigned account and refrain from unnecessary duplicate follow ups on worklist.
· Obtain prior approval from a Lead, Supervisor, or Manager for all modifications to a UB-04; including, but not limited to, additions, changes or removals to/from the original claim provided by the facility.
· Meet all weekly performance standards and goals set by leadership.
· Perform general office duties such as typing, scanning, operating office machines, and sorting documentation.
· Identify and communicate appeal deadlines to appropriate staff.
· Handle rush and high balance cases in accordance with office policy.
· Follow all HIPAA guidelines in accordance with Employee Handbook.
Supervisory Responsibility This position has no supervisory responsibilities.
Competencies
To perform the job successfully, an individual should demonstrate the following competencies:
Problem Solving – Identifies and resolves problems in a timely manner; Gathers and analyzes information skillfully.
Interpersonal Skills – Focuses on solving conflict, not blaming; Maintains confidentiality.
Oral Communication – Listens and gets clarification; Responds well to questions.
Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Able to read and interpret written information.
Teamwork – Balances team and individual responsibilities; Contributes to building a positive team spirit.
Professionalism – Accepts responsibility for own actions; Follows through on commitments.
Quality – Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality.
Attendance/Punctuality – Is consistently at work and on time.
Dependability – Follows instructions, responds to management direction; Commits to long hours of work when requested by management to reach goals.
Initiative – Takes independent actions; Asks for and offers help when needed.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
Associates or technical degree; or one to two years related experience and/or training; or equivalent combination of education and experience.
Certificates, Licenses, Registrations
This position has no certification, licensure or registration requirements.
Language Skills
Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports and business correspondence. Ability to effectively present information and respond to questions from groups of managers, clients, customers, and the general public.
Mathematical Skills
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Reasoning Ability
Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Computer Skills
To perform this job successfully, an individual should have knowledge of Internet software; Spreadsheet software and Word Processing software. Be proficient with alpha and numeric computer data entry
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee frequently is required to sit for extended periods of time; use hands to touch, handle or feel; and reach with hands and arms.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package. To learn more, visit: R1RCM.com.The US base pay range for this position is $15.00 – $20.95. Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.
Learn more about Benefits at R1
Working in an evolving healthcare setting, we use our shared expertise to deliver innovative solutions. Our fast-growing team has opportunities to learn and grow through rewarding interactions, collaboration and the freedom to explore professional interests.
Our associates are given valuable opportunities to contribute, to innovate and create meaningful work that makes an impact in the communities we serve around the world. We also offer a culture of excellence that drives customer success and improves patient care. We believe in giving back to the community and offer a competitive benefits package including:
- Comprehensive Medical, Dental, Vision & RX Coverage
- Paid Time Off, Volunteer Time & Holidays
- 401K with Company Match
- Company-Paid Life Insurance, Short-Term Disability & Long-Term Disability
- Tuition Reimbursement
- Parental Leave