ABOUT NCH
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.
JOB SUMMARY
The Revenue Cycle Denial & Appeal Lead will support and assist the Manager Revenue Cycle in organizing and coordinating all aspects of back-office revenue cycle activities for NCHMD from electronic billing, denial management, education, appeals and on the job training. The Revenue Cycle Denial & Appeal Lead will assist the Manager with staff reviews, reviewing adjustment requests, and staff audits.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Other duties may be assigned.
· Must have all requirements/knowledge of a Revenue Cycle Denial & Appeal Specialist.
· Assist and support the Manager Revenue Cycle in the department and operation of the entire Revenue Cycle Denial Specialist Team.
· Assists with department banking, moving undistributed credits, and payment posting as directed by Management.
· Approves requests for adjustments as directed by Management.
· Meets with designated payer representatives and assigned staff members regarding provider network participation, credentialing, billing issues, and medical reimbursement policy regulations.
· Serves as an onsite resource by performing productivity/accuracy audits on Revenue Cycle Denial & Appeal Specialists and identifying and reporting billing issues to appropriate leadership staff within a timely manner.
· Assumes responsibility for the timely accurate and compliant billing activities and the follow-up collection/appeals.
· First point of contact to address questions and concerns of staff members and to provide guidance and resolution as well as training.
· Identifies personal and professional areas for improvement and actively seeks out ways to meet personal development needs.
· Demonstrates understanding of all aspects of NCHMD complete Revenue Cycle compliance elements of billing.
· Works closely with Revenue Cycle Specialist Team and Compliance Department for audits/reporting/complaint billing issues, etc.
· Maintain and model standards of excellence.
· Ensures confidentiality of all patient accounts by following HIPAA guidelines.
· Stays current on industry regulations and requirements.
EDUCATION, EXPERIENCE AND QUALIFICATIONS
· Minimum of High School Diploma or GED required; Associates Degree preferred.
· Minimum of 3 years medical and billing experience or related job experience required.
· Certified Professional Biller (CPB) from American Academy of Professional Coders, CPC credential from AmericanAcademy of ProfessionalCoders (AAPC), or CCA credential from American Health Information Management Association (AHIMA) preferred.
· Excellent customer service and communication skills.
· Proficiency in computer keyboarding skills required.
· Ability to use MS Office Suite (Word, Excel, Outlook) at an intermediate level.
· Detail oriented, analytical skills, root cause analysis, ability to problem solve and recommend solutions.
· Knowledge of medical terminology, ICD-10, HCPCS and CPT-4 codes required.
· Must be detail oriented with the ability to work independently.
· Must display excellent interpersonal skills.
· Strong leadership skills.
