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Practice made perfect

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Appeals Representative in ONSITE at TeamHealth

Date Posted: 3/12/2023

Job Snapshot

Job Description

JOB DESCRIPTION OVERVIEW:

 

This position is responsible for reviewing various carrier denials at their assigned Billing Group and submitting appeals accordingly.  Maintains accuracy and production to ensure invoices are being processed efficiently.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

  • Reviews ETM task list assignment, comments, and rebills/appeals claim as necessary
  • Reviews denials to determine appropriate action based on carrier requirements
  • Posts appropriate rejection codes into system where applicable
  • Obtains status by establishing carrier contact if the submitted appeal has yielded no response
  • Identifies and forwards documentation to appeal disputed claims
  • Assembles and forwards appropriate documentation to the senior representative for provider and carrier related issues
  • Reviews carrier provider manuals for billing updates as needed
  • Reports any consistent errors found during review that affect claims from being processed correctly
  • Participates in department meetings with Accounts Receivable Team
  • Identifies trends in claims filed outside carrier timely filing deadlines and offers suggestions to prevent future occurrences
  • Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
  • Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager

 

Job Requirements

EXPERIENCE / SKILLS:     

 

  • One year medical billing experience
  • Knowledge of physician billing policies and procedures
  • Computer literate
  • Ability to work in a fast-paced environment
  • Excellent organizational skills
  • Ability to work independently

 

EDUCATION:

 

  • High school diploma or equivalent.

 

WORKING CONDITIONS:

 

  • This job will be performed in a well-lighted and well-vented environment. Requires constant sitting tolerance. Involves extensive computer use.
  • Set in a pleasant, high-volume, fast-paced office environment.
  • Overtime may be required and can be mandated by Management.

 

DISCLAIMER:

 

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the Manager. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.