Description:
REMOTE - this position will be fully remote after training. (Texas, Montana, Mississippi, Louisiana, Georgia, Oklahoma, and North Carolina residents only).
Job purpose
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The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.
Duties and responsibilities
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Reviews and appeal unpaid and denied claims
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Attaches appropriate documents to appeal letters
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Researches and evaluates insurance payments and correspondence for accuracy
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Logs appeals and grievances, and tracks progress of claims
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Keeps up-to-date reports and notates any trends pertaining to insurance denials
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Calls insurance companies to inquire about claims, refund requests and payments
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Manages Accounts Receivable reports for the Billing Department
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Utilizes EMR system to submit and correct claims
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Posts patient and insurance payments
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Sends paper claims to insurance carriers
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Answers patient billing questions
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Coordinates medical and billing records payments with patients and/or third-party payers
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Handles collections on unpaid accounts
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Identifies and resolves patient billing complaints
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Answers phone calls to the Billing Department in a timely and professional manner
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Processes credit card payments over the phone and in person
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Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
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Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
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Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
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Has regular and predictable attendance
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Adheres to Advanced Pain Care’s Policies and procedures
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Performs other duties as assigned
Requirements:
Qualifications
Education: Requires a high school diploma or GED
Experience: Three or more years related work experience of training
Knowledge, Skills and Abilities:
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Clear and precise communication
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Ability to pay close attention to detail
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Effectively manages day by organizing and prioritizing
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Possesses excellent phone and customer service skills and abilities
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Protects patient information and maintains confidentiality
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Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
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Familiarity with analyzing electronic remittance advice and electronic fund transfers
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Experience interpreting zero pays and insurance denials
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Competence in answering patient questions and concerns about billing statements
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Organizational skills and ability to identify, analyze and solve problems
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Works well independently as well as with a team
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Strong written and verbal communication skills
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Interpersonal/human relations skills
Working conditions
Environmental Conditions: Medical Office environment
Physical Conditions:
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Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
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Must be able to sit and/or stand for prolonged periods of time
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Must be able to bend, stoop and stretch
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Must be able to lift and move boxes and other items weighing up to 30 pounds.
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Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.