RCO Appeals Hearing Specialist

Intermountain Health • Santa Fe, NM • 2d ago

Job Description:

The RCO Appeals Hearing Specialist is responsible for investigating, coordinating and managing legal insurance cases and represents Intermountain Health in OIG hearings and 1st level grievances with insurance companies and CMS. This position communicates regularly with various levels of internal and external personnel and works closely with Intermountain Health legal team, Physician Advisors, and Appeals RN consultants in their various capacities.

We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Rhode Island, Vermont, and Washington.

Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings

Essential Functions

Serves as the Intermountain Appeals liaison to Legal, Appeals RN Consultants, Physician Advisors, Payor Contracting and various internal and external departments within Intermountain Healthcare.

Understands ERISA, self-funded and federal and state laws around 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.

Acts with minimal supervision while making many complex decisions daily within the scope of the position. Keeps staff educated on all current trends in the appeals arena.

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.

Skills

Critical thinking

Healthcare law

Communication

Organizational skills

Computer Literacy

Medical terminology

Problem Solving

Health Insurance

Collaboration

Detail-oriented

Physical Requirements:

Qualifications

Required

Demonstrated experience working as a legal assistant, hearing officer, paralegal or in a compliance support role.

Demonstrates strong ability to connect/collaborate with internal and external customers to provide training and education.

Demonstrated knowledge of Revenue Cycle and health insurance industry.

Demonstrates excellent written communication skills.

Demonstrates in-depth knowledge of state and federal laws governing health insurance contracts and the appeal process.

Demonstrated proficiency in computer skills including Microsoft Office, internet and email required.

Preferred

Bachelor's degree in legal related field from an accredited institution. Education will be verified.

Paralegal certificate.

Experience with Epic .

Physical Requirements

Ongoing need for employee to see and read information, documents, monitors, identify equipment and supplies, and be able to assess customer needs.

Frequent interactions with providers, colleagues, customers, patients/clients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, needs, and issues quickly and accurately.

Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use for typing, accessing needed information, etc.

May have the same physical requirements as those of clinical or patient care jobs, when the leader takes clinical shifts.

For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location:

Lake Park Building

Work City:

West Valley City

Work State:

Utah

Scheduled Weekly Hours:

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$30.55 - $48.12

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 package here (https://intermountainhealthcare.org/careers/benefits) .

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.

At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.

All positions subject to close without notice.

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