Job Description

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Work Shift

Day

Work Day(s)

Monday-Friday

Shift Start Time

8:00 AM

Shift End Time

4:30 PM

Worker Sub-Type

Regular

Children’s is one of the nation’s leading children’s hospitals. No matter the role, every member of our team is an essential part of our mission to make kids better today and healthier tomorrow. We’re committed to putting you first, and that commitment is at the heart of our company culture: People first. Children always. Find your next career opportunity and make a difference doing what you love at Children’s.

Appeals third-party denials, trends payor and coding issues to maximize collections, and identifies root cause of payment denial sources to specific revenue cycle or clinical processes (e.g., patient accounting/follow-up, utilization review/case management, coding, medical necessity). Collects information on each case, summarizes clinical issues, and ensures that it is processed and followed to final resolution in a timely manner.

Experience

• 3 years of experience in billing/collections/reimbursement in a hospital healthcare setting
• 2 years of experience in utilization review and/or case management in a hospital or insurance-related setting

Preferred Qualifications

• Licensed Practical Nurse (LPN) or Certified Professional Coder (CPC)

Education

• Associates degree or 3-5 years previous experience in billing, collections, reimbursement in hospital/health care setting

Certification Summary

• No professional certifications required

Knowledge, Skills, and Abilities

• Must have demonstrated excellent written communication skills

Job Responsibilities

• Appeals third-party administrative and clinical denials to achieve expected reimbursement following payor requirements.
• Provides clinical information to insurance companies as needed for completion of certification processes.
• Ensures needed clinical information is documented into all billing systems.
• Drafts appeal letters to insurance carriers based on both clinical and administrative information on accounts.
• Performs timely follow-up on denials and tracks outcomes.
• Maintains effective communication strategies so that collaboration and teamwork are enhanced throughout department and Children’s Healthcare of Atlanta.
• Stays current with payor regulations and appeals processes.
• Maintains professional development.
• Works collaboratively with Utilization Review and Central Access Authorization teams and other departments.

Children’s Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability or any other characteristic covered by applicable law.

Primary Location Address

1575 Northeast Expy NE

Job Family

Patient Financial Services