Insurance Appeals Assoc

Covenant Health

Covenant Health is the region’s top-performing healthcare network with 10 hospitals, outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division. Headquartered in Knoxville, Covenant Health is a community‑owned integrated healthcare delivery system and the area’s largest employer. Our more than 11,000 employees, volunteers, and 1,500 affiliated physicians are dedicated to improving the quality of life for the more than two million patients and families we serve every year.

Covenant Health is the only healthcare system in East Tennessee to be named a Forbes “Best Employer” seven times.

This position is responsible for building patient accounts in the denials management system and performing timely follow‑up with regard to clinical and medical necessity insurance appeals. The associate analyzes all correspondence regarding insurance denials for the Revenue Integrity Auditor to take appropriate action, prepares necessary documentation for the insurance appeals process to ensure timely follow‑through, processes claim adjustments for leadership approval, posts payments as needed, and maintains the integrity of the denials management database for accurate statistical and educational reporting.

The associate also provides feedback to Revenue Integrity Auditors and Patient Account Representatives as it relates to department operations.

• Analyze denials and coordinate insurance appeals.
• Recognize situations that necessitate supervision and guidance, and seek appropriate resources.
• Ensure team members are compliant with front‑end and back‑end appeals hand‑offs, maintaining payer correspondence and claims processing.
• Notify Appeals Supervisor or Revenue Integrity Manager when trends are identified while processing claim denial correspondence and following up on appeals.
• Document all activities in denials management and financial systems to ensure timely handoffs.
• Demonstrate the ability to understand billing regulations and payer requirements.
• Handle varying tasks and understand patient accounting processes relative to the revenue process to ensure appropriate reimbursement is received.
• Communicate effectively with patients/public, co‑workers, physicians, facilities, agencies, and other facility personnel using verbal, nonverbal, and written communication skills.
• Follow policies, procedures, and safety standards; complete required education assignments annually; work toward achieving goals and objectives; and participate in quality improvement initiatives as requested.

Minimum Education: One specified; will accept any combination of formal education and/or prior work experience sufficient to demonstrate possession of the knowledge, skill and ability needed to perform the essential tasks of the job, typically such as would be equivalent to a high school diploma or GED.

Minimum Experience: Two (2) years of experience in hospital billing or insurance pre‑certification required; must be familiar with healthcare billing and insurance regulations such as those required by Medicare, Medicaid or commercial payers. Computer experience is required.

Licensure Requirements: None.