Insurance Specialist

Argentum Medical • Yorkville, TN

9d

About The Position

Core Responsibilities: • Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment. • Independently write professional appeal letters. • Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as WCR policies and procedures. • Submit retro-authorizations in accordance with payor requirements in response to authorization denials. • Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution. • Make recommendations for additions/revisions/deletions to claim edits to improve efficiency and reduce denials. • Identify opportunities for process improvement and actively participate in process improvement initiatives.   Customer Service Standards: • Support co-workers and engage in positive interactions. • Communicate professionally and timely with internal and external customers. • Ability to stay calm under pressure and deal effectively with insurance company associates

Responsibilities

• Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment.
• Independently write professional appeal letters.
• Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines as well as WCR policies and procedures.
• Submit retro-authorizations in accordance with payor requirements in response to authorization denials.
• Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution.
• Make recommendations for additions/revisions/deletions to claim edits to improve efficiency and reduce denials.
• Identify opportunities for process improvement and actively participate in process improvement initiatives.
• Support co-workers and engage in positive interactions.
• Communicate professionally and timely with internal and external customers.
• Ability to stay calm under pressure and deal effectively with insurance company associates

What This Job Offers

• Education Level: No Education Listed
• Number of Employees: 51-100 employees