·Responsible for the review and appeal of administrative authorization denials. Coordinates with the appeals/denial recovery specialists for escalated reviews, as needed.
The Ideal Candidate Will Have:
Knowledge of third party reimbursement, charging and coding guidelines.
Preferred - Soarian experience.
Reviews denials and identifies root cause of denial.
Makes primary determination whether denial might be overturned. Contacts insurance company to appeal.
Calculates expected reimbursement denied dollars for both contracting and non-contracting insurance companies.
Resolves reimbursement discrepancies using knowledge of reimbursement methodologies including, but not limited to, Per-Diem, DRG, fee schedule, percentage of charges, and stop loss.
Understands medical coding systems effecting the adjudication of claims payment. These include ICD, CPT, HCPCS, DRG, APG, APC, and revenue code structures.
Credentials and Qualifications:
·Associate’s Degreein Healthcare, Finance or other required.
·A minimum of two (2) years related experience in health care required. *Seven (7) years of related healthcare experience may be considered in lieu of an Associate's degree.*
To create a Moffitt culture of diversity and inclusion as we strive to contribute to the prevention and cure of cancer.
Moffitt Cancer Center is recognized as the model wherein the diversity of our employees and communities is valued and supported as essential components to contributing to the prevention and cure of cancer.
The cancer center is an equal opportunity employer. It is the policy of the cancer center to prohibit unlawful discrimination and harassment of any type and to afford equal employment opportunities to workforce members and applicants, regardless of race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, marital status, disability, genetic information, veteran’s status or any other characteristic protected by federal, state or local law.