Intermountain Healthcare Appeals Specialist I in Layton, Utah

Job ID:205508
Greater Ogden & North Davis area

About Us

What does it mean to be a part of Intermountain Healthcare? It means that the quest for clinical excellence is not just a goal, but a given. It means building an environment where physicians and employees can deliver the best in healthcare. And it’s realizing each employee or volunteer is vital to the healing process, because we can only achieve theextraordinary together .

Being a part of Intermountain Healthcare means joining with a world-class team of over 36,000 employees and embarking on a career filled with opportunities, strength, innovation, and fulfillment. Our mission is: Helping people live the healthiest lives possible.

Our patients deserve the best in healthcare, and we deliver.

Job Description

Investigates and examines denial accounts and applies appropriate methods and techniques as established internally to resolve applicable issues, follows through with unresolved accounts, provides feedback to the appropriate staff on where the process went wrong, and keeps staff educated on all current trends in the appeals arena.

Essential Job Duties

  • 1. Investigates and examines source of denials utilizing knowledge of charge master, AS400, ICD-9 coding, CPT coding and EDI billing.
  • 2. Reads and interprets expected reimbursement information from EOB's and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB.
  • 3. Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission.
  • 4. Works with HIM and PAS across the enterprise in resolving adverse benefit determinations.
  • 5. Work closely with Appeals staff (Letter writers, Case Managers and Hearing specialists) in obtaining all pertinent information in a timely manner.
  • 6. Performs duties as given by supervisor to fill in where needed: covering phones, sorting mail, scanning and filing or any other office function within the CAU.
  • 7. Maintains and follows all HIPAA and confidentiality requirements.

Posting Specifics

  • Entry Rate: $15.33
  • Benefits Eligible: Yes
  • Shift Details: M-F Day Shift (Shift to be determined at time of hire)
  • Department: Central Appeals Unit - Medicare Advantage

Minimum Requirements

  • Demonstrated extensive knowledge in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third Party contracts, minimum of two years experience in a specified area.
  • Demonstrated excellent analytical, fact-finding, problems solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients, and insurance plan administrators.
  • Demonstrated ability to work successfully in a team setting.

Physical Requirements

  • Interact with others requiring the employee to communicate information.
  • Operate computers and other office equipment requiring the ability to move fingers and hands.
  • See and read computer monitors and documents.
  • Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Please Note

All positions subject to close without notice. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Additional Details:

Working Hours 29

Primary Work Location Layton Office Building

Expertise Clerical / Secretarial / Business Office Support

Job Type Full Time

Location US-UT-Layton