Aspirion
Revenue Cycle Management Services | Advanced Technology, Top Talent, Optimal Revenue Results
Manager, Appeals – Underpayments
Location
California
Posted
11 days ago
Salary
$68K / year
Bachelor Degree5 yrs expExperience acceptedEnglishSQL
Job Description
• Analysis of hospital contracts to identify potential underpayment opportunities
• Translation of contract terms into mathematical formulas to identify underpaid claims
• Identify opportunities for process improvements for both client and internal processes
• Manage day-to-day work of 15-20 direct reports
• Train staff in the areas of underpayment identification, healthcare industry processes and standards, communicating and negotiating with insurance companies
• Escalate and resolve payment disputes with payer and serve as a liaison between client and payer
• Establish metrics to monitor staff performance; prepare and deliver performance evaluations and resolve any staff related issues
• Provide Subject Matter Expertise support with clients and staff
Job Requirements
- Thorough understanding of reimbursement methodologies (Health Insurance contracts, Medicare, and Medicaid)
- Excellent written and verbal communication skills
- Knowledge of government compliance rules and issues as it pertains to healthcare billing and reimbursement
- Comfort with large data sets, manipulating data in SQL, MS Access and comparable database platforms
- Proven leader, experience managing teams; ability to motivate and mentor junior staff
- Self-directed and organized with analytical and problem-solving skills
- Comfortable presenting to both internal and external stakeholders, including C-suite level members
- Ability to develop logic to price claims under various reimbursement methodologies including coordination of benefits, third party liability, Diagnosis Related Groups (DRGs), Case Rates, Ambulatory Payment Classification (APC), Outpatient Fee Schedules, Division of Financial Responsibility (DoFR) and Capitation
- Knowledge of the charge capture processes; prior experience conducting charge capture audits is a plus
- Balance and maintain day-to-day operational duties while also performing providing leadership responsibilities
- Company wide engagement and leadership
Benefits
- health, dental, vision and life insurance upon hire
- matching 401k
- competitive salaries
- advancement opportunities
- incentive programs
