Utilization Review Appeals Specialist

Description

Complete appeals for inpatient and observation cases through the payer appeal processes and complete RAC appeals according to federal and state guidelines. Participate in venues to reduce risk of lost revenue is essential. Review, assess and interpret patient encounters to ensure accurate information on billed claims. Collaborate with multiple departments to maintain compliance with third party payer requirements and to ensure CMS regulations are met. RHIT is required. Employees in this classification typically analyze, compare and evaluate various courses of action and have the authority to make independent decisions on matters of significance, free from immediate direction, within the scope of their responsibilities. Primary activities and decision making authority are predominantly performed independently affecting business operations to a substantial degree. Under FLSA, this is the exempt job classification for this title. Incumbents in this position must meet the full criteria for exempt status: salary level, salary basis, and duties tests.