An Appeal specialist ensures the quality and efficiency of Appeal Resolution for providers in a timely manner. The responsibilities of this position include but are not limited to, Appealing denials, Obtaining status of submitted appeals, Quality Assurance, and other such duties as the company may assign.
The billing department looks for individuals who are detail oriented and use their time efficiently with the ability to multi-task. Appeal Specialists have strong communication skills and are able to work with the team to resolve and prevent problems.
An Appeal Resolution Specialist gains exposure to many of the complex tasks within the job function. Occasionally directed in several aspects of the work.
Primary Responsibilities:
- Investigating & resolving claim denials.
- Maintaining detailed notes and records.
- Responding to and completing appeals for low payments, denials, medical necessity denials.
- Fulfilling Medical Records requests.
- Data input
- Communicating internally and with external customers to ensure timely review / resolution.
- Identifying trends and/or root cause of issues, propose potential solutions to management.
- Evaluating appeal details and propose recommendations based on findings.
- Maintaining strict confidentiality and adhere to all HIPAA guidelines and regulations.
- Other duties as assigned by management.
Required Skills:
- Communicate effectively with all levels of staff and clients.
- Documenting / Maintaining notes effectively.
- Formulating resolution letters.
- Effective utilization of a computer and related software.
Education:
High School Diploma or equivalent.
Experience (Preferred not required):
- Experience in Behavioral Health Industry / Billing.
- Appeals and Record Request Resolutions.
Job Type: Full-time
Pay: $17.00 - $20.00 per hour
Benefits:
- Dental insurance
- Employee assistance program
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
- Monday to Friday
Experience:
- Behavioral Health: 1 year (Preferred)
- Appeal Resolution: 1 year (Preferred)
- Medical Billing: 1 year (Preferred)
Work Location:
Company's website:
Benefit Conditions:
- Waiting period may apply
- Only full-time employees eligible
Work Remotely:
COVID-19 Precaution(s):
- Remote interview process
- Personal protective equipment provided or required
- Temperature screenings
- Social distancing guidelines in place
- Sanitizing, disinfecting, or cleaning procedures in place
Work Location: In person