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Job Description:
Responsible for investigating, coordinating and managing legal insurance cases. This position communicates regularly with various levels of internal and external personnel and works closely with Intermountain Lawyers, Physician Advisors, and Clinical Appeal consultants in their various capacities. The candidate is responsible for presenting complex information, they represent Intermountain in OIG hearings and 1st level grievances before insurance companies and CMS in person and in teleconferences. Serves as a resource and provides training to internal staff members as well as various departments regarding insurance issues or trends as necessary. This position reports to the Manager of Appeals.
• Serves as the Centralized Appeals liaison to Legal, Clinical Appeals Consultants, Physician Advisors, Payor Contracting and various internal and external departments within Intermountain Healthcare.
• Reviews, understands, interprets and implements ERISA, self-funded, federal and state laws that apply to health insurance claims.
• Develops and maintains collaborative relations with Intermountain legal, physicians and RN Consultants to coordinate and conduct grievance hearings. 1) Provides detailed review summary to assist attorneys/physician advisors 2) Participates through representation in formal grievance hearings, medical review boards and courts of law 3) Educates third party payers, ALJ’s and appeal boards during hearing processes related to patient’s clinical condition or care rendered.
• Assists the legal department and outside legal counsel in preparation for disputes being reviewed through mediation, small claims court and other civil actions including arbitration that are not being resolved through the formal appeal process.
• Stays current with emerging hearing procedures for all encompassed commercial, federal and state funded insurances/programs.
• Organizes and conducts hearings and acts with minimal supervision while making many complex decisions daily within the scope of the position.
• Educates employees on current trends in the appeals area by researching procedures and processes for appealing all levels offered by each insurance company and all applications of state and federal laws as they pertain.
• Serves as a subject matter expert, resource and mentor to others within the RCO, clinical departments, Appeal RN’s, legal, IPAS and Payor Contracting on the art of appealing.
Minimum Qualifications
• Demonstrated experience in health insurance billing, follow-up, denials or appeals.
Preferred Qualifications
• Four years’ experience in health insurance billing, follow-up, denials or appeals.
• Bachelor’s degree or 2 years experience working as a legal assistant, hearing office, paralegal or in a compliance support position. Paralegal certificate from an American Bar Association certified program.
• Previous experience working with employer benefit plans and their interpretation.
• Previous management or supervisory experience.
Physical Requirements:
Anticipated job posting close date:
07/08/2024
Location:
Lake Park Building
Work City:
West Valley City
Work State:
Utah
Scheduled Weekly Hours:
40
The hourly range for this position is listed below. Actual hourly rate dependent upon experience.
$29.66 – $46.72
We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.
Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers (https://intermountainhealthcare.org/careers/working-for-intermountain/employee-benefits/) , and for our Colorado, Montana, and Kansas based caregivers (http://www.sclhealthbenefits.org) ; and our commitment to diversity, equity, and inclusion (https://intermountainhealthcare.org/careers/working-for-intermountain/diversity/) .
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.
