Appeals Negotiator - NSA

PHI - Quality Care Through Quality Jobs • Phoenix, AZ

4d • Onsite

About The Position

Are you ready to elevate your career to new heights? PHI Health is looking for dynamic, driven individuals to join our team. We are committed to providing top-tier emergency medical services with unmatched speed and efficiency, saving lives when every second counts. By supporting our mission from the ground, you will play a crucial role in orchestrating the seamless operations that keep our advanced fleet soaring and our patients safe. With PHI Health you’ll collaborate with the best minds in the industry, driving initiatives that enhance our services and expand our reach to those who need it most. If you're passionate about making a difference and thrive on challenges, PHI Health offers an extraordinary opportunity to impact lives and develop your professional career in a meaningful way.
Job Summary: The appeals negotiator is responsible for ensuring the highest reimbursement for all underpaid contractual and non-contractual payers. The negotiator will build and maintain outstanding relationships with all payers while adhering to PHI reimbursement policies. The negotiator will identify, document, and assist in the collections of all contracted and non-contracted underpayments from the payers. The negotiator will provide and produce thorough supporting documentation regarding additional payment for the level of services that were rendered. This position provides oversight and resolution for claim denials that require written response. This includes denials for medical necessity, low "usual and customary" payments, not to the closest facility, and reduction to ground level payments. This position requires a high level of knowledge in compliance, federal and state regulations, and clinical record information extraction. This position reports to the leadership of Patient Financial Services.

Requirements

• High School diploma or GED required.
• 5+ years' experience in medical billing, surgical billing, billing in emergency medical services and collections preferred.
• Medicare, Managed Care, Workers' Comp. experience.
• 3-5 years of experience in appeals and negotiation background.
• Expertise in billing software and Internet-based research required.
• Must have solid knowledge of patient account systems, revenue management processes, workflow systems and the ability to troubleshoot and suggest improvements.
• Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees both with the client and with PFS.
• Must have demonstrated experience in researching statutes and understanding regulatory documents.
• Must demonstrate the ability to draft a professional and effective appeal letter.
• Ability to verbally communicate details and understand parameters of job responsibilities.
• Ability to provide written communication using best business practices when composing letters, memorandums, and e-mails regardless of if the communication is inside the Company or with customers, clients, or providers.
• Ability to read, write and follow specific instructions in both written and verbal form.
• Requires an in-depth understanding of compliance, regulatory oversight bodies and payer requirements.
• Team player, interfaces well with employees.
• Represents the company in a positive, customer friendly attitude to other employees, clients, agencies, entities and patients.
• May have supervisory responsibility.
• This position is designated Safety Sensitive for purposes of the Arizona Medical Marijuana Act.

Nice To Haves

• Bachelor's degree preferred with 5 years related work experience.

Responsibilities

• Ensuring the highest reimbursement for all underpaid contractual and non-contractual payers.
• Building and maintaining outstanding relationships with all payers while adhering to PHI reimbursement policies.
• Identifying, documenting, and assisting in the collections of all contracted and non-contracted underpayments from the payers.
• Providing and producing thorough supporting documentation regarding additional payment for the level of services that were rendered.
• Providing oversight and resolution for claim denials that require written response. This includes denials for medical necessity, low "usual and customary" payments, not to the closest facility, and reduction to ground level payments.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 251-500 employees