Appeals Specialist
Appeals Specialist
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Responsibilities:
- Review assigned denials and EOBs for appeal filing information. Gather any missing information.
- Review case history payer history and state requirements to determine appeal strategy.
- Obtain patient and/or physician consent and medical records when required by the insurance plan or state.
- Gather and fill out all special appeal or review forms.
- Create appeal letters attach the materials referenced in the letter and mail them.
- Coordinate phone hearings with the insurance company patient and physician.
- Comply with all 1st 2nd 3rd and External Level Appeal process system and documentation SOPs.
- Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks.
- Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager.
- Participate in team and appeal meetings by sharing the details of cases worked.
- Act as a backup on answering incoming telephone calls as needed.
- May undertake special projects assigned by the Team Leader or Reimbursement Manager.
- Ability to meet predetermined Productivity Goals based on the level of Appeal.
- Ability to meet Quality Standard in place 90 or greater).
- Other duties as assigned.
Qualifications:
- High School diploma or GED
- Minimum of four years health insurance billing experience
- Knowledge of managed care industry including payer structures administrative rules and government payers
- Proficient in all aspects of reimbursement
- Ability to maintain confidentiality
- Detail oriented
- Possess excellent written and verbal communication skills
- Able to establish priorities work independently and proceed with objectives without supervision.
- Proficient in using Microsoft Excel and Word
Required Experience:
Unclear Seniority
Employment Type
Full-Time
