Revenue Cycle Medical Billing Commercial Appeal Specialist

Global Medical Response•West Plains, MO

5d•Hybrid

About The Position

The Revenue Cycle Medical Billing Commercial Appeal Specialist supports the functions of the Appeal team by assisting in the review of denied and underpaid claims for the formal appeal and dispute process with the payor. Responsibilities include, but are not limited to: classification of appeals, research of accounts, preparing documents, obtaining appeal status, and review of appeal determinations.

Requirements

Must be fluent in English
Minimum of one (1) year of advanced medical billing experience
Professional written and verbal communication skills
Knowledge and experience of computers and related technology
Ability to work independently with little or no direction and as a member of a team
Knowledge of health care billing procedures, reimbursement, third party payer regulations, documentation, and standards
Understanding and interpretation of Explanation of Benefits (EOB) from payors
Strong problem-solving skills, attention to detail, and ability to make timely decisions
Excellent internal and external customer service skills
Responsiveness and a strong commitment to meeting internal and external deadlines with limited supervision

Nice To Haves

High School diploma or equivalent, or significant relevant work experience
Call Center environment work experience
Above average knowledge of insurance billing guidelines and policies
Experience with Commercial Insurance appeal and reconsideration processes

Responsibilities

Review Explanation of Benefits, denial letters and payor correspondence to classify type of appeal required.
Gather, prepare, and review documentation & various forms needed to submit appeals correctly per payor guidelines.
Engage patients via phone and/or mail to obtain requested information pertaining to the appeal process.
Document the details, requirements, and deadlines of each individual appeal in billing software.
Manage daily workflow through reports to ensure accounts are processed within required timeframes.
Follow-up with payors regarding status of appeals in a timely manner.
Identify payor issues within the appeal process and discuss potential improvements and workflow solutions with leadership.