Covenant Health

Job Title
INSURANCE APPEALS STAFF
ID
3551314
Facility
Covenant Health Corporate
Department Name
REV INTEGRITY & UTIL

Overview

COVENANT HEALTH 5.8.2023

 

Insurance Appeals Staff

Full Time, 80 Hours Per Pay Period, Day Shift

 

Covenant Health Overview:

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

 

Position Summary: 

This position provides direction for the Financial Services staff with regard to clinical and medical necessity insurance denials.  Analyzes all correspondence regarding insurance denials for the Revenue Integrity Auditor to take appropriate action.  Prepares necessary documentation for insurance appeals process, ensuring timely follow through.  Processes claim adjustments for leadership approval and posts payments as necessary. Maintains integrity of denials management database for accurate statistical and educational reporting.  Provides feedback to Revenue Integrity Auditors, Patient Account Representatives and external vendors as it relates to department operations.  

 

Recruiter: Kathleen Rice || kkarnes@covhlth.com || 865-374-5386

Responsibilities

  • Develops and maintains departmental policies and procedures, implementing new policies and procedures relative to financial services and appeals processing.
  • Analyze denials and coordinates insurance appeals.
  • Ensures team members are compliant with front end and back end appeals hand-offs, maintaining payer correspondence and claims processing.
  • Notifies Appeals Supervisor or Revenue Integrity Manager when trends are identified while processing claim denial correspondence and follow-up of appeals.
  • Assist with all insurance requested audits and provides information to Appeals Supervisor related to inaccurate and/or missing documentation.
  • Documents all activities in denials management and financial systems to ensure timely handoffs.
  • Able to identify and review problem accounts to determine reason(s) for and resolution of issues
  • Assists the Reconciliation and Recovery team to resolve payment, denial and contractual issues.
  • Communicates effectively with patients/public, co-workers, physicians, facilities, agencies and/or their offices and other facility personnel using verbal, nonverbal, and written communication skills.
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Qualifications

Minimum Education:                        None 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.  Preference may be given to individuals possessing an Associate’s degree in a directly-related field from an accredited college or university.

 

Minimum Experience:                      Three (3) or more years of experience in hospital billing or insurance pre-certification required; prefer one (1) or more years insurance appeals experience. 

 

Licensure Requirements:                 None.

 

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