Appeals Representative

Requirements

EXPERIENCE / SKILLS:
• One-year medical billing experience
• Knowledge of physician billing policies and procedures
• Computer literate
• Ability to work in a fast-paced environment
• Excellent organizational skills
• Ability to work independently


EDUCATION:
• High school diploma or equivalent.


WORKING CONDITIONS:
• This job will be performed in a well-lighted and well-vented environment. Requires
constant sitting tolerance. Involves extensive computer use.
• Set in a pleasant, high-volume, fast-paced office environment.
• Overtime may be required and can be mandated by Management.


DISCLAIMER:
Cooperative, positive, courteous and professional behavior and conduct is an essential function
of every position. All employees must be able to work with others beyond giving and receiving
instructions. This includes getting along with co-workers, peers and management without
exhibiting behavior extremes. Job functions may require personal leadership skills such as
conflict resolution, negotiating, instructing, persuading, speaking with others as well as
responding appropriately to job performance feedback from the Manager. Additionally, the
information contained in this job description has been designated to indicate the general nature
and level of work performed by employees within this classification. It is not designed to contain
or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications
required of employees assigned to this position.

External Job Description and Responsibilities

TeamHealth is named among the Top 150 Places to Work in Healthcare by Becker's Hospital Review. Newsweek Magazine recognizes TeamHealth as 'one of the greatest workplaces for diversity, 2024'and TeamHealth is also ranked as 'The World's Most Admired Companies' by Fortune Magazine. TeamHealth, an established healthcare organization is physician-led and patient focused. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us.

What we Offer:
Career Growth Opportunities
Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
401K (Discretionary matching funds available)
Generous PTO
8 Paid Holidays
Equipment Provided for Remote Roles

JOB DESCRIPTION OVERVIEW: This position is responsible for reviewing various carrier denials at their assigned Billing Group and submitting appeals accordingly. Maintains accuracy and production to ensure invoices are being processed efficiently.

ESSENTIAL DUTIES AND RESPONSIBILITIES:
• Reviews ETM task list assignment, comments, and rebills/appeals claim as necessary
• Reviews denials to determine appropriate action based on carrier requirements
• Posts appropriate rejection codes into system where applicable
• Obtains status by establishing carrier contact if the submitted appeal has yielded no response
• Identifies and forwards documentation to appeal disputed claims
• Assembles and forwards appropriate documentation to the senior representative for provider and carrier related issues
• Reviews carrier provider manuals for billing updates as needed
• Reports any consistent errors found during review that affect claims from being processed correctly
• Participates in department meetings with Accounts Receivable Team
• Identifies trends in claims filed outside carrier timely filing deadlines and offers suggestions to prevent future occurrences
• Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
• Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager