Acct Assistant – Coding & Appeal F​/U

Join to apply for the Acct Assistant 4 – Coding & Appeal F/U role at Yale University

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Join to apply for the Acct Assistant 4 – Coding & Appeal F/U role at Yale University

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Hourly Range

31.05

Overview Under the direction and supervision of the Associate Director and Team Lead/Manager, employee will be responsible for insurance follow-up on carrier denials with a focus on coding denials for Yale Medicine. Employee will also function as a liaison in the day-to-day follow-up of denied and no-response claims to obtain maximum reimbursement for services rendered by Yale Medicine and other related practices.

Follow up of denied and appealed claims for Yale Medicine and its related specialties and practices. Follow up of provider ineligible denials according to the rejection code posted in Epic and follow process guidelines established by the Central Business Office management team. Follow up of coding denials according to the rejection code posted in Epic and follow process guidelines established by the Central Business Office management team.

Process and review carrier denials for adherence to specific payer Explanation of Benefits. Knowledge of appealing denials in order to receive maximum reimbursement for Yale Medicine. Write, send and follow up on appeals as appropriate by contacting the carrier, researching carrier policies, review of medical documentation and/or work collaboratively with YM staff to ensure maximum reimbursement. Directly communicate with third party insurance carriers, patients, and other listed payers in order to investigate payment/reimbursement delays for billed charges, for both primary and secondary claims.

Respond to requests from insurance carriers, Yale Medicine clinical departments and/or patients for supporting documentation necessary in order to obtain maximum reimbursement. Work closely with other centralized and non centralized units within the Business Office to resolve outstanding claim/billing/payer issues or requests. Identify and report carrier/specialty issues that will assist in claim processing and resolution. Responsible for documentation and follow up of claims worked through payment, rejection or appeal.

Strong knowledge of insurance carrier and specialty related issues. Review and validate charge review and claim edits as assigned to ensure correct coding and in compliance with Yale Medicine guidelines. Ability to review and understand medical records and coding. Interact with all Yale Medicine departments as required to resolve matters relevant to coding, fees, medical documentation and other problems to expedite the processing of claims, payments and rejections.

Special projects as assigned by Yale Medicine staff and management and all other job related duties. Required Skills and Abilities 1. Knowledge and working ability with CPT, ICD
10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edit’s (MUE’s). Working knowledge and ability with Microsoft Office especially Excel and Word.
2. Computer data entry ability. Strong attention to detail.
3. Ability to work independently and as part of a team. Ability to multi-task in a high volume environment. Strong verbal and written communication skills.
4. Excellent attendance and reliability.
5. Ability to be highly energetic and motivated with the ability to work under pressure and handle/maintain a high volume of accounts. Preferred Education, Experience and Skills Working ability of EPIC and EPIC work queues. Current CPC certification.

Principal Responsibilities

• Serves as a principal source of information on rules and procedures governing University accounts receivable. Oversees and instructs support staff.
  2. Oversees maintenance of account files, ensuring accuracy and completeness. Reviews…