Appeals Negotiator

PHI - Quality Care Through Quality Jobs•Phoenix, AZ

1d•Onsite

About The Position

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.
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.
Demonstrated experience in researching statutes and understanding regulatory documents.
Demonstrated 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.
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.

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, including denials for medical necessity, low "usual and customary" payments, not to the closest facility, and reduction to ground level payments.
Researching statutes and understanding regulatory documents.
Drafting a professional and effective appeal letter.
Verbally communicating details and understanding parameters of job responsibilities.
Providing written communication using best business practices when composing letters, memorandums, and e-mails.
Representing the company in a positive, customer friendly attitude to other employees, clients, agencies, entities and patients.