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Denials and Appeals Representative in Alcoa, TN at TeamHealth

Date Posted: 2/11/2019

Job Snapshot

Job Description

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
  • Free Parking
  • Free coffee daily
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Awesome Facility with terrific amenities
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

This position is responsible for reviewing denials assigned to Appeals Role in ETM. Maintains accuracy and production to ensure denials are being processed efficiently. The responsibilities of the position include, but are not limited to the following:

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Reviews ETM list to identify trends and carrier issues that need to be reported to management.
  • Reviews EOB’s/denials to determine appropriate action based on carrier requirements.
  • Assembles and forwards documentation to carrier for appeal disputed claims.
  • Handles correspondence related to Medicare, Medicaid, Blue Cross Blue Shield, Managed Care and Tenncare according to written procedure.
  • Assembles and forwards appropriate documentation to the Senior Representative for provider related issues.
  • Maintain knowledge of carrier requirements for appeal completion.
  • Maintain knowledge of ETM system.
  • Report any consistent errors found during review that affect claims from being processed correctly.
  • Participates in monthly meeting with Appeals Supervisor.
  • Turns to Supervisor for unusual circumstances that may include write-offs, denials, fee schedules, claims, etc.
  • Performs any and all duties as directed by Senior Representative, Appeals Supervisor and Accounts Receivable Manager.

Job Requirements

QUALIFICATIONS / EXPERIENCE:

  • Demonstrated knowledge of physician billing.
  • Demonstrated knowledge of health care reimbursement guidelines.
  • Knowledge of ICD-10 and CPT-4 coding.
  • Good oral and written communication.
  • Detailed in completing Appeal documentation.
  • Knowledge of appeals and review policies for all plans.
  • Thorough working knowledge of physician billing policies and procedures.
  • Computer literate.
  • Excellent follow-up skills.
  • Excellent organizational skills.
  • High school diploma or equivalent.
  • Minimum two years previous medical billing experience preferred with emphasis on research and claim denials in Accounts Receivable.
  • Training classes and seminar attendance may require travel.

SUPERVISORY RESPONSIBILITIES:

  • None

PHYSICAL / ENVIRONMENTAL DEMANDS: 

Set in a pleasant, high-volume, fast-paced office environment. Involves extensive computer use.

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 supervisor. 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.