Senior Appeals Specialist

Senior Appeals Specialist

Job Category: Medical Billing

Full-Time

Remote

Middleburg Heights, OH 44130, USA +1 more locations

Description

Key Responsibilities:

• Work as needed in all appeal worklists, potentially with a focus on contracted or sensitive insurance companies.
• Communicate denial and appeal trends to client engagement and payer relations teams.
• Serve as an SME (subject matter expert) in insurance appeals matters and work with management to relay updates to clients.
• Obtain patient consent and medical records for appeal when required by the insurance plan.
• Gather updated appeal or review forms to add to form library.
• Create appeal letters, attach the materials per client SOP, and submit via portal/fax/mail.
• Comply with all appeal process documentation and SOPs.
• Participate in team meetings, sharing case details. Provide the best practices for other team members.
• Train new or less experienced appeals team members.
• Undertake special projects assigned by Production Management or client.
• Review denials and EOBs for appeal filing information, gathering any missing details.
• Inform management of incorrect or missing appeal default information.
• Fill out special appeal or review forms.
• Initiate payer projects, complete as assigned, including creating and maintaining tracking spreadsheets.
• Ability to work on additional work lists as needed.
• Work directly with global teams to demonstrate processes.
• Once in the role, work to obtain Lean Six Sigma (LSS) Yellow Belt or higher.
• Meet or exceed productivity and quality KPI goals.
• Perform other duties as assigned.

Education/Experience:

• High School diploma or GED
• Minimum of four years' health insurance billing experience, or equivalent degree
• Minimum of one-year Quadax production experience
• Proficient with PAS and HARP systems
• Excellent written and verbal communication skills
• Knowledge of managed care industry including payer structures, administrative rules, and government payers
• Proficient in all aspects of reimbursement
• Able to work independently and prioritize tasks
• Ability to maintain confidentiality
• High attention to detail
• Proficient computer skills with knowledge of Microsoft Excel and Word

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.