Medical Records & Appeals Specialist

ODYSSEY BEHAVIORAL GROUP•Franklin, TN

2d•Onsite

About The Position

The Medical Records & Appeals Specialist is responsible for processing insurance and self-pay claims with a general knowledge of all revenue cycle functions including benefits, billing, and cash posting. This position supports business office leaders and team members as a subject matter expert and resource for training, questions, and escalations. The role involves maintaining close and frequent contact with finance and revenue cycle team members within both the facility-based teams and Odyssey, as well as with insurance providers and third-party vendors.

Requirements

High school diploma
Two (2) years of directly related experience
Ability to communicate with peers/public, clients and/or vendors
Ability to move throughout the building as well as sit or remain stationary for extended periods of time
Ability to talk or hear, sit, stand, or walk
Strong attention to detail
Strong problem solving and analytical skills
Strong customer service skills
Proficiency with Microsoft Office (Word and Excel)
Excellent organizational and time management skills
Successful collaborative skills working with a variety of groups
Functional knowledge of basic behavioral health terminology
Demonstrated familiarity with insurance billing policies and practices
Commitment to the mission, vision, and values of Odyssey Behavioral Healthcare

Nice To Haves

Bachelor's degree preferred

Responsibilities

Assists team members as the initial check point for guidance, escalated issues and/or training.
Runs basic reporting and data analysis, as assigned by leadership.
Coordinates with leadership to prioritize assignments based on business needs.
Assists leadership with projects and complex or escalated accounts, as assigned.
Processes outstanding insurance claims to point of resolution.
Creates, tracks, submits, and manages insurance appeals and medical records requests throughout the appeals process, as needed.
Handles coordination of benefit and coverage termed issues.
Reports insurance reimbursement trends and barriers to leadership.
Ensures revenue cycle functions are performed in compliance with all company and regulatory requirements, protecting the privacy of client information.
Communicates essential information to all necessary team members in a timely and accurate manner.
Manages and uploads scanned documents such as client insurance authorizations.
Reviews client accounts, self-pay balances, and communicates information to clients and/or facility team members including gathering client statements, as needed.
Maintains knowledge of revenue cycle best practices and insurance carrier trends.
Functions within the guidelines of the corporate Code of Ethics and in accordance with Corporate Compliance standards.
Reads, understands, adheres to, and models all company policy statements on ethics, conduct, and conflict of interests.
Attends and completes all training within assigned time frames.
Performs other duties as assigned.