Paralegal

Administrative Appeals Assistant

This position is responsible for assisting with the filing of administrative appeals and documentation to health insurers and governmental payers.

Duties and responsibilities include:

• Works well with attorneys and paralegals.
• Quickly and efficiently prepares, reviews, and submits well-written appeals and related documents to insurance carriers and government payers.
• Answers phones in a timely manner using good customer service skills and judgement in the distribution of messages.
• Develops and manages processes for optimizing the legal team's work.
• Conduct research on claim details, insurance benefits, eligibility, and payer requirements to support appeals.
• Follow up with insurance carriers to obtain claim status and drive resolution of outstanding appeals.
• Manages the database.
• Assist with projects as needed.
• Is comfortable, skilled, aggressive, cordial, and professional on the telephone to follow up on submitted appeals.
• Access and navigate hospital EMRs and payer portals to retrieve clinical and claim information.
• Identify denial trends and contribute to process improvements that enhance appeal success rates.
• Performs any other administrative duties as may be necessary.

Qualifications:

• Bachelor's Degree (BA) from four-year college or university, or one to two years of related experience and/or training, or equivalent combination of education and experience.
• Certificates, licenses and registrations desired: Paralegal certification.
• Other skills required:

1. Undergraduate degree with a GPA of 3.0 or higher.
2. Proficiency in Microsoft Office including Word and Excel.
3. Interest in healthcare and healthcare law.
4. Highly organized, aggressive, outgoing, and detail-oriented.
5. Clear, concise, and logical writing style.
6. Must be highly attentive to detail and be able to handle large amounts of paperwork for a busy office.
7. Must have excellent organizational skills.

Competencies:

• Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.
• Analytical - Synthesizes complex or diverse information; Collects and researches data; Uses intuition and experience to complement data; Designs work flows and procedures.
• Business Necessity – The needs of the employer may be dependent on responding to and anticipating rapidly changing external and internal demands in all aspects of how business is conducted. This may include, but is not limited to, organization structure, finances, goals, personnel, work processes, technology, and customer demands. Therefore, it may become necessary to make modifications to how business is conducted, and work is accomplished, with minimal or no advance notice to employees. Accordingly, the employee must be capable of adapting, with minimal or no advance notice, to changes in how business is conducted, and work is accomplished, with no diminishment in work performance.
• Customer Service - Manages difficult or emotional customer situations; Responds promptly to customer needs; Solicits customer feedback to improve service; Responds to requests for service and assistance; Meets commitments.
• Dependability - Follows instructions, responds to management direction; Takes responsibility for own actions; Keeps commitments; Commits to long hours of work when necessary to reach goals; Completes tasks on time or notifies appropriate person with an alternate plan.
• Design - Generates creative solutions; Translates concepts and information into images; Uses feedback to modify designs; Applies design principles; Demonstrates attention to detail.
• Diversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.
• Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethically; Upholds organizational values.