RCO Appeals Specialist
Intermountain Health, West Valley City, UT, United States
The RCO Appeals Specialist is responsible for researching and appealing denied medical claims. Proactively identify insurance denial trends and collaborate with Payer Contracting to address these issues.
Essential Functions
Understand and apply various contracts and laws (e.g., ERISA, self‑funded, State and Federal insurance) to appropriately appeal denied medical claims.
Conduct investigations and refer patient accounts to payers, audit firms, or internal departments to assess billing accuracy, chargemaster data, revenue cycle data, and UB/HCFA1500 information.
Interpret denial reasons, review payer contracts, clinical data, and other sources to craft concise, accurate appeals.
Assess the appropriateness of clinical appeal requests using evidence‑based utilization review criteria, payer policies, and Federal and State regulations.
Refer appeal cases to the designated Physician Advisor and secure support for appeals.
Collaborate with Care Management, Physician Advisors, Revenue Integrity, Compliance, legal counsel, and RSC teams to prepare appeals.
Identify trends and opportunities for denial prevention and work with multidisciplinary teams to improve denial management, documentation, and the appeals process.
Support legal counsel in preparing for Administrative Law Judge hearings as part of the appeal process.
Serve as a subject‑matter expert, resource, and mentor for others within the RCO, clinical departments, Appeal RN’s, legal, IPAS, and Payor Contracting teams.
Skills
Medical billing
Interpersonal skills
Communication
Healthcare regulations
Insurance regulations
Medical terminology
Critical thinking
Problem solving
Patient advocate
Collaboration
Qualifications – Required
Demonstrated experience in a healthcare revenue cycle role.
Proficiency in computer skills, including Microsoft Office, internet, and email.
Exceptional written communication skills.
Knowledge of State/Federal/ERISA and self‑funded insurance laws.
Qualifications – Preferred
Experience in healthcare insurance billing, follow‑up, denials and appeals, or audit roles.
Bachelor’s degree preferred.
Experience with Epic preferred.
Physical Requirements
Ongoing visual and reading requirements for documents and monitors.
Frequent verbal communication with providers, colleagues, and patients.
Manual dexterity for handling complex and delicate equipment, including frequent computer use.
Requirements may mirror those of clinical or patient care jobs.
Driving may be required; involves reading signs and traffic signals.
Location Lake Park Building, West Valley City, Utah
Scheduled Weekly Hours: 40
Hourly Rate: $21.84 – $33.23 (dependent on experience)
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.
All positions subject to close without notice.
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Essential Functions
Understand and apply various contracts and laws (e.g., ERISA, self‑funded, State and Federal insurance) to appropriately appeal denied medical claims.
Conduct investigations and refer patient accounts to payers, audit firms, or internal departments to assess billing accuracy, chargemaster data, revenue cycle data, and UB/HCFA1500 information.
Interpret denial reasons, review payer contracts, clinical data, and other sources to craft concise, accurate appeals.
Assess the appropriateness of clinical appeal requests using evidence‑based utilization review criteria, payer policies, and Federal and State regulations.
Refer appeal cases to the designated Physician Advisor and secure support for appeals.
Collaborate with Care Management, Physician Advisors, Revenue Integrity, Compliance, legal counsel, and RSC teams to prepare appeals.
Identify trends and opportunities for denial prevention and work with multidisciplinary teams to improve denial management, documentation, and the appeals process.
Support legal counsel in preparing for Administrative Law Judge hearings as part of the appeal process.
Serve as a subject‑matter expert, resource, and mentor for others within the RCO, clinical departments, Appeal RN’s, legal, IPAS, and Payor Contracting teams.
Skills
Medical billing
Interpersonal skills
Communication
Healthcare regulations
Insurance regulations
Medical terminology
Critical thinking
Problem solving
Patient advocate
Collaboration
Qualifications – Required
Demonstrated experience in a healthcare revenue cycle role.
Proficiency in computer skills, including Microsoft Office, internet, and email.
Exceptional written communication skills.
Knowledge of State/Federal/ERISA and self‑funded insurance laws.
Qualifications – Preferred
Experience in healthcare insurance billing, follow‑up, denials and appeals, or audit roles.
Bachelor’s degree preferred.
Experience with Epic preferred.
Physical Requirements
Ongoing visual and reading requirements for documents and monitors.
Frequent verbal communication with providers, colleagues, and patients.
Manual dexterity for handling complex and delicate equipment, including frequent computer use.
Requirements may mirror those of clinical or patient care jobs.
Driving may be required; involves reading signs and traffic signals.
Location Lake Park Building, West Valley City, Utah
Scheduled Weekly Hours: 40
Hourly Rate: $21.84 – $33.23 (dependent on experience)
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.
All positions subject to close without notice.
#J-18808-Ljbffr