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Job Requirements of Sr Appeals Representative:
EXPERIENCE / SKILLS: Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable.
Demonstrated knowledge of physician billing.
Demonstrated knowledge of health care reimbursement guidelines especially Medicare and Medicaid.
Knowledge of ICD-9, ICD-10 and CPT-4 coding.
Good oral and written communication.
Knowledge of appeals and reviewing policies for state and government plans.
Thorough working knowledge of physician billing policies and procedures.
Computer literate.
Excellent follow-up skills.
Excellent organizational skills.
Knowledge of Microsoft Office applications such as Excel and Word.
EDUCATION:
High school diploma or equivalent.
WORKING CONDITIONS:
Set in a pleasant, high-volume, fast-paced office environment.
Involves extensive computer use.
Overtime may be required and can be mandated by Management.
TRAVEL:
Training classes and seminar attendance may require travel.
Do you meet the requirements for this job?
Sr Appeals Representative
TeamHealth
Louisville, TN (Hybrid)
Full-Time
JOB DESCRIPTION OVERVIEW:
The Appeals Senior is responsible for maintaining accuracy and production for the department, overseeing daily functions of employees and training of department staff. The senior provides leadership and guidance to the Representatives in the Appeals Roles. The department’s goal is to examine and take action to support the provider’s interests in submitting appeals to insurance carriers and appropriately reporting any claims and/or provider issues for correction.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reviews ETM PIT reports daily to provide guidance to employees on effectively organizing and working assignments.
Provides training to new staff, as well as, in service training of established staff.
Reviews invoices to determine appropriate action based on carrier requirements.
Assembles and forwards documentation to appeal disputed claims.
Reports any consistent errors found that affects claims from being processed correctly.
Participates in departmental meetings.
Reviews and appeals claims that have been denied and that appropriately require intervention. This includes assembling documentation, documenting IDX and maintaining files of appealed claims for possible legal intervention. Communicates with Supervisor and/or AR Manager to keep them informed of any detected problems or changes in AR.
Performs any and all duties as directed by the Supervisor, and/or Account Receivables Manager.
Performs quality audits on Appeals staff members.
Assists with research and development of appropriate appeals procedures.
Creates and updates policy and procedures for department.
Researches denials to determine if claim issue and/or provider issue exists and forwards to the appropriate department for correction.
Other duties as assigned by the Accounts Receivable Manager.
The Appeals Senior is responsible for maintaining accuracy and production for the department, overseeing daily functions of employees and training of department staff. The senior provides leadership and guidance to the Representatives in the Appeals Roles. The department’s goal is to examine and take action to support the provider’s interests in submitting appeals to insurance carriers and appropriately reporting any claims and/or provider issues for correction.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Reviews ETM PIT reports daily to provide guidance to employees on effectively organizing and working assignments.
Provides training to new staff, as well as, in service training of established staff.
Reviews invoices to determine appropriate action based on carrier requirements.
Assembles and forwards documentation to appeal disputed claims.
Reports any consistent errors found that affects claims from being processed correctly.
Participates in departmental meetings.
Reviews and appeals claims that have been denied and that appropriately require intervention. This includes assembling documentation, documenting IDX and maintaining files of appealed claims for possible legal intervention. Communicates with Supervisor and/or AR Manager to keep them informed of any detected problems or changes in AR.
Performs any and all duties as directed by the Supervisor, and/or Account Receivables Manager.
Performs quality audits on Appeals staff members.
Assists with research and development of appropriate appeals procedures.
Creates and updates policy and procedures for department.
Researches denials to determine if claim issue and/or provider issue exists and forwards to the appropriate department for correction.
Other duties as assigned by the Accounts Receivable Manager.
Job Requirements:
EXPERIENCE / SKILLS:
Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable.
Demonstrated knowledge of physician billing.
Demonstrated knowledge of health care reimbursement guidelines especially Medicare and Medicaid.
Knowledge of ICD-9, ICD-10 and CPT-4 coding.
Good oral and written communication.
Knowledge of appeals and reviewing policies for state and government plans.
Thorough working knowledge of physician billing policies and procedures.
Computer literate.
Excellent follow-up skills.
Excellent organizational skills.
Knowledge of Microsoft Office applications such as Excel and Word.
EDUCATION:
High school diploma or equivalent.
WORKING CONDITIONS:
Set in a pleasant, high-volume, fast-paced office environment.
Involves extensive computer use.
Overtime may be required and can be mandated by Management.
TRAVEL:
Training classes and seminar attendance may require travel.
Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable.
Demonstrated knowledge of physician billing.
Demonstrated knowledge of health care reimbursement guidelines especially Medicare and Medicaid.
Knowledge of ICD-9, ICD-10 and CPT-4 coding.
Good oral and written communication.
Knowledge of appeals and reviewing policies for state and government plans.
Thorough working knowledge of physician billing policies and procedures.
Computer literate.
Excellent follow-up skills.
Excellent organizational skills.
Knowledge of Microsoft Office applications such as Excel and Word.
EDUCATION:
High school diploma or equivalent.
WORKING CONDITIONS:
Set in a pleasant, high-volume, fast-paced office environment.
Involves extensive computer use.
Overtime may be required and can be mandated by Management.
TRAVEL:
Training classes and seminar attendance may require travel.
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