Responsible for reviewing and researching payment account adjudication, billing outcomes, and disputed claim patterns for commercial payors. Validates claim issues and prepares documents to support pre-legal and legal actions in Superior Court or arbitrations. Work closely with internal and external lawyers to ensure the adjudicated expected reimbursement, billing, and disputed claims systems are set up and all documents gathered and indexed to support the legal case flow. Answer questions as related to legal case preparation.
Minimum Education: • High School Diploma or GED • Associate degree in related field such as finance, accounting and/or legal, compliance • In lieu of the educational degree, at least 7 years of experience in Patient financial Services, Contracts, Financial Audit preferably in an acute care or healthcare environment. • Preferred; Degree in Paralegal Minimum Experience/Knowledge: • At least 5 years of experience in Patient Financial Services/Revenue Cycle Collections, or Managed Care Contracting preferably in an acute care hospital or healthcare environment. • Strong analytical functions and knowledge of patient accounting key principals. • Strong written and verbal communication skills. • Strong analytical skills and excellent excel and report capability with the ability to multi-task • Strong knowledge of managed care and other healthcare contract language, contract language and reimbursements • Strong understanding of ICD10, HCPCS/CPT coding, medical terminology and hospital bill form requirements (UB04) • Strong knowledge and skills in Microsoft Excel to create pivot tables, v-lookup functions, and query writing • Previous account review experience. Audit background a plus Required License/Certification: • Fire and Safety Certification. If no card upon hire, one must be obtained within 30 days of hire, and maintained by renewal before expiration date. • Preferred: Paralegal certificate
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