Billing Appeals Specialist - Hospital Appeals

PeaceHealth•Vancouver, WA

About The Position

The Billing Appeals Specialist is responsible for resolving appeals related to technical issues identified during billing and follow-up. The role initiates, processes, and resolves appeals to support appropriate reimbursement and appropriate days in Accounts Receivable. The specialist writes formal appeals to insurance companies for reimbursement, processes and tracks correspondence and technical denials, researches appeals, and communicates with payors and providers to resolve denials. The role also reports complex issues to the clinical auditor and Appeals Team Manager, produces denial and recovery reports, ensures compliance with organizational and regulatory guidelines, processes claims in accordance with contracts and policies, and settles claims as appropriate. This is a non-employee, non-clinical contractor position listed as 1.00 FTE and a day position. Work is predominantly in an office environment, with the ability to work remotely with minimal oversight also required.

Requirements

High school diploma or equivalent.
At least 2 years of experience in billing or insurance account follow-up.
Medical coding school or education specific to medical billing.
Medical terminology experience.
Knowledge of medical insurance processes, billing guidelines, and regulations.
Ability to read and understand insurance EOBs and payor contracts.
Proficient use of computers, including Microsoft Office applications.
Skilled in 10-key by touch and keyboarding.
Ability to operate general office equipment.
Excellent verbal and written communication skills.
Excellent attention to detail and ability to multitask.
Ability to work independently with minimal supervision and collaboratively as part of a team.
Strong organizational skills and ability to prioritize and meet deadlines.
Knowledge of commercial and/or government payors.
Ability to identify, research, and resolve credit balances, missing payments, payment recoupments, and unposted cash related to billing account follow-up.
Ability to work remotely with minimal oversight, independently, and collaboratively in a team setting.

Nice To Haves

Medical coding knowledge.
Epic experience.
Medical Billing Certification.
Certified Revenue Cycle Representative credential.
HealthStream Badge.

Responsibilities

Write appeals to insurance companies for reimbursement of monies owed and initiate formal appeals.
Process and maintain patient and insurance-company correspondence related to logging, tracking, and processing technical denials.
Research appeals to evaluate, respond to, and close them.
Identify complex appeal issues and report them to the clinical auditor and Appeals Team Manager.
Communicate appeal issues with payors and providers to help resolve denials.
Produce reports of received denials, including their disposition and recoveries.
Ensure compliance with organizational and regulatory guidelines.
Process claims in accordance with contracts and policies and settle claims as appropriate.
Communicate with insurance companies, patients, co-workers, and supervisors.
Perform other duties as assigned.