Job Details

Healthcare Receivables Staff Attorney

Company name

Organization Type

Law Firm

Job Type

Attorney

Date Last Verified

May 04, 2021

Valid Through

Aug 17, 2021

Posted on

Jan 09, 2021

Years of Experience

3-5 yrs required

Location

Baltimore, MD, United States

Employment Type

Full-time

Industry

Legal
Practice Area
Health Care >> Health Care
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Healthcare Receivables Staff Attorney
The candidate will be responsible for performing legal research on unpaid and denied hospital accounts, successfully working with insurance companies via phone as well as the preparation and writing of appeal letters, CMS and State Complaints in order to obtain additional reimbursement for the Clients. Research current State and Federal healthcare regulations, while maintaining a current database for office wide use. Draft monthly legal research articles to be published on Cloudmed online blog and distributed to clients as appropriate. Assist in writing and researching topical informational videos for clients to be published on the Cloudmed YouTube channel. Validate the accuracy of the denial and capture/document the detailed CAS code reason(s) and remark codes. Based on the detailed finding of the denial, initiate retrieval of all related and supporting documentation needed for inclusion in the appeal letter. Identify if there is the need to include clinical team into the review and appeal process based on the denial. Draft and submit all high balance appeals for all team members per assigned clients. Research payer specific guidelines and contract language to include when applicable for appeal submissions. Conduct appropriate account activity on accounts by contacting government agencies, third party payors, and patients/guarantors via phone, e-mail, or online. Continue follow up collection activity with payor on assigned complex inventory until account is resolved. Responsible for maintaining inventory and ensuring that daily productivity standards of assigned accounts are met. Identify payor issues and trends and escalate findings to Management. Participate on calls with hospital clients, highlighting high balance account statuses. Facilitate communication between management and payor provider representatives on escalated inventory, maintaining documentation and tracking of such issues. Participate on combined calls and meetings with payors and clients, providing inventory reviews, trend analysis, and escalation of account issues. Complete demand letters, State Complaints, and CMS Complaints in response to egregious payor behavior as applicable. Participate in additional levels of dispute resolution based on the client needs, including IRO’s and Maximus appeals. Assist management in auditing team members’ accounts, providing feedback and guidance to the team as needed. Review payor contracts with hospital clients to ensure applicable language is included in any technical appeal, and request new versions of contracts as appropriate from the client to maintain a database. Maintain a professional and HIPAA compliant work area. Perform other required duties in a timely, professional, and accurate manner. Ensure compliance with State and Federal Laws, Regulations for Managed Care and other Third-Party Payors.

Qualification and Experience

The candidate should have JD degree and Law License in good standing. 3-5 years of Healthcare experience preferred. Must have strong analytical skills and strong proficiency in Microsoft Office Tools. Able to communicate effectively and professionally with strong attention to detail and problem solving both verbally and written. trong telephone communication skills are required. Intermediate understanding of Explanation of Benefits form (EOB), Managed Care Contracts, Contract Language and Federal and State Statutes. Intermediate understanding of ICD-10, HCPCS/CPT coding and medical terminology. Intermediate Microsoft Office (Word, Excel) skills. Advanced business letter writing skills to include correct usage of grammar and punctuation. Strong interpersonal skills is essential. Above average analytical and critical thinking skills. Familiar with terms such as HMO, PPO, IPA and Capitation. Intermediate understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.

Additional info

Requisition ID: 1121

Company info

Hiring Coordinator
Fotheringill & Wade, LLC
212 Washington Avenue
Baltimore, MD 21204

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