ONSITE Appeals Specialist - Addison, TX
About The Position
- Review and analyze denied claims, payment discrepancies, and reimbursement issues to identify the root causes. - Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and accurate submissions. - Prepare compelling appeal letters, supporting documentation, and necessary forms to present a strong case for claim reconsideration. - Stay up-to-date with payer policies, regulations, and industry trends related to claim appeals and arbitration. - Maintain a comprehensive understanding of coding guidelines, medical necessity, and reimbursement methodologies to strengthen appeal arguments.
Requirements
- Ms office suite
- medical record
- medical terminology
- medical biller
- anesthesia
- Proven experience as an Appeals Specialist or in a similar role within a healthcare setting.
- In-depth knowledge of healthcare revenue cycle processes, claim adjudication, and reimbursement methodologies.
- Familiarity with insurance denials, appeals, and arbitration processes, including knowledge of payer-specific appeal requirements and guidelines.
- Strong understanding of medical coding (CPT, HCPCS, ICD-10) and medical terminology.
Responsibilities
- Review and analyze denied claims, payment discrepancies, and reimbursement issues to identify the root causes.
- Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and accurate submissions.
- Prepare compelling appeal letters, supporting documentation, and necessary forms to present a strong case for claim reconsideration.
- Stay up-to-date with payer policies, regulations, and industry trends related to claim appeals and arbitration.
- Maintain a comprehensive understanding of coding guidelines, medical necessity, and reimbursement methodologies to strengthen appeal arguments.
Benefits
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
