APPEALS SPECIALIST

UHS•Las Vegas, NV

About The Position

The Western Region Consolidated Business Office delivers comprehensive insurance revenue services to our affiliated UHS facilities, encompassing billing, collections, cash posting, pre-access management, variance analysis, and customer service. Our dedication to associate satisfaction and growth is recognized by industry leaders, exemplifying our commitment to fostering a positive and inclusive workplace culture. Our associates can count on competitive salaries, top-tier medical, dental, and retirement benefits, career training, and support for continued professional development. The role involves managing denied claims by identifying reasons for denial or dispute and collaborating closely with Nurse Auditors to support medical necessity appeals. This position requires preparing and submitting accurate appeal documentation, conducting thorough research to gather supporting evidence, and ensuring timely follow-up and resolution of appeals.

Requirements

2 years healthcare/collection experience and/or equivalent experience in a hospital setting.
Minimum of 2 years of previous Collections/Appeals experience.
High school diploma or equivalent.
Track the status of appeals, follow up regularly, and escalate issues as needed to facilitate timely resolution.
Apply critical thinking and attention to detail in reviewing claims and related documentation.
Utilize interpersonal skills to effectively communicate and collaborate with internal teams and external parties.
Leverage experience with hospital acute care payer contracts to support claim resolution and appeals processes.

Responsibilities

Manage denied claims by identifying reasons for denial or dispute.
Collaborate closely with Nurse Auditors to support medical necessity appeals.
Prepare and submit accurate appeal documentation.
Conduct thorough research to gather supporting evidence.
Ensure timely follow-up and resolution of appeals.
Track the status of appeals.
Follow up regularly on appeals.
Escalate issues as needed to facilitate timely resolution.
Apply critical thinking and attention to detail in reviewing claims and related documentation.
Utilize interpersonal skills to effectively communicate and collaborate with internal teams and external parties.
Leverage experience with hospital acute care payer contracts to support claim resolution and appeals processes.