RCO Appeals Correspondence Specialist

Job Description:

The RCO Appeals Correspondence Specialist is responsible for drafting, advancing and maintaining all legal documents, letters and correspondence for appealing with third party and governmental payers to obtain reimbursement including handling difficult, hard to collect accounts that have been deemed by the insurance company to be unpayable. This position is responsible for knowing all state/federal laws that relate to insurance contracts and to the appeal process. Essential Functions Conducts analysis and resolves incorrect reimbursement issues with third party payers and recognizes when the account should become involved in a payment dispute with the insurance company. Conducts research and formulates a defense to support appeals with insurance companies and other payers as needed. Strategizes which appeal strategy should best be used (medical necessity, payer language, state/federal laws). Maintains an understanding of expected reimbursement information and legal parameters pertaining to all State, Federal, Self-Funded and ERISA regulations. Provides education and training to department staff on strategies to be used with appeals. Also educates them on the correct application and interpretation of insurance law. Updates new employees on regulations and policies and procedures surrounding appeals. Drafts, advances and maintains all legal/technical documents, letters and correspondence pertaining to all levels of appeals. Responsible to formulate, implement and maintain a procedures manual/document that encompasses the guidelines relating to the purpose of the Centralized Appeals Unit. Serves as a subject matter expert, resource and mentor to others within the RCO, clinical departments, Appeal RN's, legal, IPAS and Payor Contracting on the art of appealing. Works closely with appeal specialists in obtaining all pertinent information required for appeal letters Skills Critical thinking Health Insurance Healthcare regulations Written communication Computer Literacy Medical terminology Problem Solving Patient advocate Collaboration Detail-oriented Qualifications Required Demonstrated experience working in English Writing/Health Insurance, Public Relations or related role. Demonstrated strong knowledge of Revenue Cycle and health insurance industry. Demonstrates in-depth knowledge of healthcare insurance regulations. Demonstrates in-depth knowledge of state and federal laws governing health insurance contracts and the appeal process. Demonstrated proficiency in computer skills including Microsoft Office, internet and email required. Preferred Bachelor's degree in healthcare administration, legal studies or related field from an accredited institution. Education is verified. Experience with Epic preferred. Physical Requirements Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs. Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately. Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc. May have the same physical requirements as those of clinical or patient care jobs, when the leader takes clinical shifts.

For roles requiring driving:

Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Lake Park Building Work City:

West Valley City Work State:

Utah Scheduled Weekly Hours:

40 The hourly range for this position is listed below. Actual hourly rate dependent upon experience. $27.65 - $43.55 We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here. Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process. All positions subject to close without notice. Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment. To find out more about us, head to our career site here. Sign up for job alerts! Click 'sign in' at the top right corner, create a candidate account, and when we have opportunities that meet your interests, you will receive an email with the job details. Intermountain Health strives to make the application process accessible to all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact 1-800-843-7820 or email recruitment@imail.org. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. Introduce yourself to our Talent Acquisition team and we will get in touch if there is a role that seems like a good match. Intermountain Health's PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more. The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Only those key duties necessary for proper job evaluation and/or labor market analysis have been included. Other duties may be assigned by the supervisor. All positions subject to close without notice. Thanks for your interest in continuing your career with our team!