APPEALS SPECIALIST

UHS•Las Vegas, NV

10h•Onsite

About The Position

The Western Region Consolidated Business Office (WCBO) of Universal Health Services (UHS) delivers comprehensive insurance revenue services to affiliated UHS facilities, including billing, collections, cash posting, pre-access management, variance analysis, and customer service. The organization is dedicated to associate satisfaction and growth, fostering a positive and inclusive workplace culture. The Appeals Specialist 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

Responsibilities

Managing denied claims by identifying reasons for denial or dispute
Collaborating closely with Nurse Auditors to support medical necessity appeals
Preparing and submitting accurate appeal documentation
Conducting thorough research to gather supporting evidence
Ensuring timely follow-up and resolution of appeals
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