Description

Description This position serves as Appeals Analyst for Central Billing Office management. Responsible for monitoring contractual allowances, analyzing and pursuing appeals opportunities with payors and networks, and reporting performance on underpaid claims. Responsibilities Monitors and reports the accuracy of contract reimbursements per payor, for both under and overpaid claims. Reviews and analyzes data in our contract compliance tool (Contract Manager), EPIC, and payor policy detail for identified payment discrepancies. Verifies applicable contract lines of business by review of EOB messages, patient eligibility, and payor policy information for CBO contracted payors. Compiles and submits appeal files, by payor or network, by CPT/ HCPCS codes, by error type, or by provider, to specified payor and monitors progress for proper reimbursement through established follow-up protocols. Provides contract rate analysis to CBO groups upon request. Provides/updates contract mapping submissions when necessary. Establishes and cultivates effective contacts in payor and network offices. Prepares Adhoc payor performance metrics detailing appeals and recoveries. Monitors, tracks, and ...