Heces, Inc.Althcare Financial Resour Work Values

Daily Duties at Heces, Inc.Althcare Financial Resour:

-Medicare replacement HMO and Medicaid replacement HMO audit and appeals resulting in recoupment of greater than $3,000,000 for one client in 2004 -Direct Negotiation with Medicaid replacement HMO resulting in overturning denials on a class of claims, and revision in prior authorization policy, by payor with reimbursement of claims previously denied resulting in recoupment of over 2 million dollars in lost revenues for one client in 2004 -Created a medical review department which resulted in increased company profits of more than $200,000 in 2003 and $3,000,000 in 2004. -Spearheaded client project review for performance improvement resulting in recovery of more than $60,000 per year in lost revenues. -Collaborated with legal department on underpayment of trauma claims resulting in recovery of $4,000,000 in lost revenues in April-December 2005. -Developed standard appeals to managed care payors resulting in increased profits for one client of more than $100,000 in 2003 -Streamlined Medical Review process and Medical Records Management saving the company and our clients over $500,000 per year -Audited large balance inpatient denials and presented trends to staff to improve documentation and accounts receivable -Trained client staff in documentation and implemented processes to prevent future denials for incorrect coding and not meeting medical necessity standards. -Audited clients for viability of pursuing denied claims -Managed all clinical aspects of the business relationship with primarily large academic facilities to ensure appropriate services are available and utilized to provide the highest possible caliber of service. - Established successful communication and acted as a liaison between client billing offices, denials management departments, and payors. -Managed the daily operations of the Medical Review department including monthly reports to the executive management team and to clients.

What they like about Heces, Inc.Althcare Financial Resour:

The social vibrance of a hiring firm is very important to you. Your ability to make and maintain friendships there is a critical part of your decision. You would likely be dissatisfied with a workplace that is quiet, cold, or otherwise not particularly social. When you investigate a new hiring company, ask recruiters, managers, and potential co-workers about the social life and opportunities there. This is especially important when you are relocating; moving dramatically alters your social sphere both inside and outside the workplace.

Tags

Medicare, Medicaid, Compliance, Healthcare Audit, Denials Management, and Managed Care Relations

Skills

Managed Care Contracts Negotiation and Compliance, Cost Containment, Bad Debt Resolution, Directing and Managing, Policy Development and Implementation, Healthcare Auditing, Analysis, and Dilemma Resolution, Clinical Training, Team Building and Staff Retention, Disease Management, Wellness Education

These are some of the questions we asked our climbers about their experiences with Heces, Inc.Althcare Financial Resour: