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Job Requirements of Sr Appeals Representative - 5120:
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.
Do you meet the requirements for this job?
Sr Appeals Representative - 5120
Join a team of dynamic, results oriented professionals!
Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review
- Career Growth Opportunities
- Convenience market on site
- Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
- 401K program (Discretionary matching funds available)
- Employee Assistance Program
- Referral Program
- Dental plans & Vision plans
- GENEROUS Personal time off
- Eight Paid Holidays per year
- Quarterly incentive plans
- Business casual dress code
- Employee of the month awards with monetary gift and parking space
- Training Programs
- Fitness Center with personal trainer on site
- Wellness programs
- Flexible work schedule
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 and Provider Enrollment Research 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/Provider Enrollment Research staff members.
- Assists with research and development of appropriate appeal/provider enrollment research
- 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.