Appeals Specialist - Patient Accounts - Full Time - Days
About The Position
The Appeals Specialist will manage the organization’s third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines. This position will develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims. The Appeals Specialist will lead the organization’s denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials. The Appeals Specialist will work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports. The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
Requirements
- MINIMUM EDUCATION High School Graduate or GED Equivalent required; relevant experience in lieu of High School Diploma/GED education will be considered.
- MINIMUM WORK EXPERIENCE Three to five years of job related experience.
- REQUIRED LICENSES/CERTIFICATIONS None.
- REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES Must be computer literate; possess good verbal and written communication skills, and excellent analytical skills.
Nice To Haves
- Associate’s or Bachelor’s Degree in a Business related field highly preferred.
- Foreign Medical Graduates welcome.
Responsibilities
- Manage the organization’s third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines.
- Develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims.
- Lead the organization’s denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials.
- Work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports.
- Provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
Number of Employees
1,001-5,000 employees
