Washington University is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity or expression, national origin, genetic information, disability, or protected veteran status.
This position is full-time and works approximately 40 hours per week.
Department Name/Job Location:
This position is in the Department of Orthopaedic Surgery. The position is located at 4625 Lindell Ave., St. Louis, MO.
Acts as the liaison for Department of Orthopaedic Surgery external type appeals.� Responsible for ensuring that all appeal letters generated comply with both State and Federal guidelines.� Review clinical information for all appeals utilizing nationally recognized criteria to determine medical necessity of services provided.� Prepare appeals for cases that did not meet criteria.� Participates in special projects.� Performs advanced billing and collection activities related to underpayments and adjustments.� Identifies and resolves payor trends.� Acts as a Lead IBC Assistant.� Requires knowledge of CMS/ NCCI billing guidelines.
PRIMARY DUTIES AND RESPONSIBILITIES:
Supports customer service unit in answering billing and collection questions.
Researches and resolves Medicare, Medicaid, and Commercial claim denials.
Reviews remittance advises for accuracy of payments amounts. Analyzes the Medicare and Commercial provider contracts and agreements.
Oversees appeals process.
Reviews remittance advises for rejection and accuracy of payment amounts.
Handles discounts, adjustments, and charge corrections.
Responds to questions and requests from insurance companies.
Equivalent of High School diploma with 3 to 5 years of previous billing or insurance experience required.
2 years of college or business school preferred.
Experience with medical claims follow up and/or appeals.
Should have strong understanding of Payer websites.
Working knowledge of medical terminology, collection techniques and strong communication skills that involves handling confidential information.
Understanding of LEAN principles.�
Knowledge of third party procedures and electronic billing systems.
Knowledge of ICD-10, CPT, Revenue Codes, DRG’s.
The hiring range for this position is $18.45 - $23.06 per hour.
Whether suffering from a sports injury, hip pain, back pain or any musculoskeletal condition, Washington University Orthopedics provides a full complement of comprehensive orthopedic services to meet the needs of every patient. Combining the best in both inpatient treatment and outpatient care and rehabilitation, the practice is nationally recognized for outstanding orthopedic care, innovative research and advanced professional training. It is ranked among the best orthopedic practices and holds the distinction of being listed on the Honor Roll by U.S. News & World Report. The practice is considered an innovator in both conservative orthopedic care and minimally invasive microsurgical techniques. Affiliated with Barnes-Jewish Hospital and St. Louis Children’s Hospital, Washington University Orthopedics has the unique ability to offer inpatient treatment for the most challenging cases within a top-tier academic medical center as well as outpatient surgery and care across the St. Louis region in Chesterfield, Town & Country, South County and the Central West End. The practice offers expertise in ten orthopedic subspecialties – foot and ankle, hand and wrist, hip and knee, cancer, pediatric and adolescent orthopedics, physical medicine and rehabilitation (physiatry), shoulder and elbow, spine (including scoliosis), sports medicine and fracture care/trauma. The orthopedic specialists are dedicated to providing safe, compassionate and family-centered care for both simple and complex orthopedic conditions. Because of the skill and experience of the doctors and staff, it is the official medical provider for the St. Louis Blues hockey team, Washington University varsity athletics and several local school athletic teams. Washington University Orthopedics brings world-class care to patients from all ages and walks of life in St. Louis and the surrounding communities.
-Retirement Savings Plan -22 vacation days -8 Paid Holidays -Sick Time -Tuition benefits for employee, spouse and dependent children -Free Metro Link/ Bus pass -Free Life Insurance -Health, Dental, Vision -Health Savings Accounts (HSA) -Long Term Disability Insurance -Flex Spending Plan -Other Benefits
Med School HR website (medschoolhr.wustl.edu)
Internal Applicant Instruction:
This position is grade C08.
Please attach a copy of your most current signed performance evaluation (completed within the last 18 months) to your online account. If you have not received a performance evaluation, you may provide two current signed letters of recommendation (written within the last 18 months), preferably to include one letter from either a current or recent former supervisor. To attach these documents, go to: My Career Tools, Add Attachment, Attachment Type – Performance Reviews or Letters of Recommendation.
Washington University in St. Louis, a medium-sized, independent university, is dedicated to challenging its faculty and students alike to seek new knowledge and greater understanding of an ever-changing, multicultural world. The University offers more than 90 programs and almost 1,500 courses leading to bachelor's, master's and doctoral degrees in a broad spectrum of traditional and interdisciplinary fields, with additional opportunities for minor concentrations and individualized programs. The faculty is composed of scholars, scientists, artists and members of the learned professions. They serve society by teaching; by adding to the store of human art, creativity, understanding, and wisdom; and by providing direct services, such as health care.