Practice made perfect

Join Our Talent Network

HM Denials & Appeals Senior in Knoxville, TN - Maryville, TN - Alcoa, TN at TeamHealth

Date Posted: 8/8/2018

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 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 department. The department’s goal is to examine and take action to support the provider’s interests in submitting appeals to insurance carriers.

ESSENTIAL 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.
  • Coordinates all projects of the Patient Accounts and/or AR Management team with the manager of those assigned states.
  • Communicates with various members of the AR Management team 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 appeal procedures.
  • Creates and updates policy and procedures for department.
  • Other duties as assigned by the Accounts Receivable Manager.

Job Requirements

POSITION REQUIREMENT:

Skills

  • 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.                   
  • Training classes and seminar attendance may require travel.

TRAVEL:

Training classes and seminar attendance may require travel.

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.

Experience

  • Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable.

Education

High school diploma or equivalent.