Knowtion Health

• Receives, reviews, collates, and submits claim documents and medical records through electronic processes, with accuracy and integrity, ensuring HIPAA compliance. • Faxes claim documents, with accuracy and integrity, ensuring HIPAA compliance. • Renames electronic files of scanned mail received, ensuring it is stored in the appropriate client/patient folder. • Claim Data Entry, Such as... Retyping UB-04 and HCFA 1500s • FACS/Artiva account notation • Consequence to errors in judgment are critical (HIPAA violation fines and penalties, lost revenue for hospital client)

• Reviews medical record documentation to verify clinical indicators and coding issues as related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, etc. • Creates detailed appeal letters for denials from payer to support payment of patient claims • Manages Inventory and Follow up on accounts as appropriate • Reviews InterQual/Milliman, coding guidelines and/or payer medical policies related to denied procedures or services and includes criteria in appeals letter as appropriate • Provides feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members • Identifies root causes and trends to share with clients and staff • Works with peers in collaboration of clinical writing situations

• Provides direction on inventory to team members, daily. • Monitors inventory backlog, reviews reports (timely filing, aging, other) to ensure compliance with client protocols. • Reviews and summarizes accounts up to a designated amount for closure based on standard operating procedure for each client. • Conducts one-on-one meetings, monthly to provide coaching and mentoring to team members. • Retrieves and analyze reports relating to inventory workflow to ensure the correct accounts are being worked on by team members. • Escalates complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively.

• Provides direction on inventory to team members, daily. • Monitors inventory backlog, reviews reports (timely filing, aging, other) to ensure compliance with client protocols. • Reviews and summarizes accounts up to a designated amount for closure based on standard operating procedure for each client. • Conducts one on one meetings, monthly to provide coaching and mentoring to team members. • Retrieves and analyze reports relating to inventory workflow to ensure the correct accounts are being worked on by team members. • Escalates complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively.

• Using the Artiva workflow management system, follow up on patient bills and claims to recover revenue from the responsible business entity. • Depending on the department, the business entities may include any or all the following: commercial health insurance, governmental insurance, and third party administrators • Analyze information to identify root cause of denied or unpaid claim and determine next steps • Pursue & obtain information needed to overturn claim denials, including patient & responsible party information, medical necessity, employer information, accident information • Ensure appropriate timely filing guidelines are met for maximum reimbursement • Escalate complex, complicated, or challenging accounts to management to ensure accounts are progressing effectively • Identify and discuss root cause issues with management • Draft and submit appeals with supporting documentation to overturn claim denials • Consequence to errors in judgment are critical (HIPAA violation penalties, lost revenue for hospital client, other penalties, or fines)

• Lead requirements gathering sessions with internal and external stakeholders, translating business needs into technical configurations and implementation plans • Serve as a technical advisor during client onboarding, guiding clients on integration capabilities, limitations, and best practices • Leverage Snowflake and SQL expertise to solve complex technical challenges and collaborate with leadership to overcome implementation roadblocks • Analyze, identify, and resolve data anomalies, inconsistencies, and risks through comprehensive validation, root cause analysis, and mitigation strategies • Partner with cross-functional teams to troubleshoot issues, improve workflows, and drive continuous enhancements to implementation processes and team effectiveness

• Manage an inventory of accounts in a team-based environment for medical payments, third-party liability, and health benefits coverage • New and priority accounts to be worked within client specified protocols, including coverage investigation • Aged and high dollar accounts to be worked as necessary to ensure efficient recovery • Accounts that require substantive review by the coding and utilization departments • Accounts that require lien submissions • Identify and resolve accounts with multiple payers (PIP, Health, TPL) involved • Prepare and submit appeals with required documentation in a timely manner • Use professional notation that is clear, concise and comprehensive throughout the complex account resolution process

• Manage an inventory from multiple clients with a variety of accounts with complex issues • Prepare and submit appeals with required documentation in a timely manner • Identify and resolve any outstanding issues causing delay or non-payment of bills • Maintain professional relationships and communication with patients, employers, and payer representatives • Learn and implement client specific protocols and procedures • Demonstrate proficiency with web portals, client systems, and databases as necessary to document and resolve accounts

• Manage an inventory from multiple clients with a variety of accounts with complex denials • New and priority accounts to be worked within 48 business hours • Aged and high dollar accounts to be worked as necessary to ensure efficient revenue cycle recovery • Accounts that require substantive review by the coding and utilization departments • Identify and resolve denials to obtain timely payment for clients • Prepare and submit appeals with required documentation in a timely manner • Use professional notation that is clear, concise and comprehensive throughout the complex claim resolution process • Maintain professional relationships and communication with patients and payer representatives • Learn and implement client specific protocols and procedures • Demonstrate proficiency with web portals, client systems, and databases as necessary to document and resolve accounts • Identify recent payer resolution trends and relay them to peers • Communicate questions and concerns proactively to supervisor for resolution

• Review medical record documentation to verify medical necessity issues as related to length of stay, level of care, readmissions, experimental/investigational, etc. • Create detailed clinical analyses and appeal letters for denials from payer to support payment of patient claims • Managing Inventory and Following up on accounts as appropriate • Review InterQual/Milliman and/or payer medical policies related to denied procedures or services and include criteria in analysis/appeal letter as appropriate • Provide feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members • Identify root cause and trending to share with clients and staff