Medical Records & Appeals Specialist

Medical Records & Appeals Specialist

Franklin, TN

Overview

Level: Experienced Position Type: Full Time Education Level: High School Category: Finance

Description

Position Summary

The Medical Records & Appeals Specialist is responsible for processing insurance and self-pay claims with a general knowledge of all revenue cycle functions including benefits, billing, and cash posting. Position supports business office leaders and team members as a subject matter expert and resource for training, questions, and escalations.

Relationships and Contacts

Within the organization: Maintains close and frequent contact with the finance and revenue cycle team members within both the facility-based teams and Odyssey.

Outside the organization: Maintains close and frequent contact with insurance providers and third-party vendors, as necessary.

Position Responsibilities

Essential Responsibilities

• Assists team members as the initial check point for guidance, escalated issues and/or training.
• Runs basic reporting and data analysis, as assigned by leadership.
• Coordinates with leadership to prioritize assignments based on business needs.
• Assists leadership with projects and complex or escalated accounts, as assigned.
• Processes outstanding insurance claims to point of resolution.
• Creates, tracks, submits, and manages insurance appeals and medical records requests throughout the appeals process, as needed.
• Handles coordination of benefit and coverage termed issues.
• Reports insurance reimbursement trends and barriers to leadership.
• Ensures revenue cycle functions are performed in compliance with all company and regulatory requirements, protecting the privacy of client information.
• Communicates essential information to all necessary team members in a timely and accurate manner.
• Manages and uploads scanned documents such as client insurance authorizations.
• Reviews client accounts, self-pay balances, and communicates information to clients and/or facility team members including gathering client statements, as needed.

Additional Responsibilities

• Maintains knowledge of revenue cycle best practices and insurance carrier trends.
• Functions within the guidelines of the corporate Code of Ethics and in accordance with Corporate Compliance standards.
• Reads, understands, adheres to, and models all company policy statements on ethics, conduct, and conflict of interests.
• Attends and completes all training within assigned time frames.
• Performs other duties as assigned.

Qualifications

Minimum Requirements

Education and Experience

Position requires a high school diploma, bachelor's degree preferred, and two (2) years of directly related experience

Physical Requirements

While performing the duties of this job, the employee will be required to communicate with peers/public, clients and/or vendors

Job performance will require the ability to move throughout the building as well as sit or remain stationary for extended periods of time

While performing the duties of this job, the employee may be required to talk or hear, sit, stand, or walk

Skill Competencies

Demonstrates strong attention to detail

Demonstrates strong problem solving and analytical skills

Demonstrates strong customer service skills

Demonstrates proficiency with Microsoft Office (Word and Excel)

Demonstrates excellent organizational and time management skills

Demonstrates successful collaborative skills working with a variety of groups

Demonstrates functional knowledge of basic behavioral health terminology

Demonstrated familiarity with insurance billing policies and practices

Demonstrates commitment to the mission, vision, and values of Odyssey Behavioral Healthcare

Odyssey Behavioral Healthcare, LLC and its subsidiaries provide equal employment opportunities without regard to race, color, creed, ancestry, national origin, ethnicity, sex, gender, sexual orientation, marital status, religion, age, disability, gender identity, genetic information, service in the military, or any other characteristic protected under applicable federal, state, or local law. Equal employment opportunities apply to all terms and conditions of employment. Odyssey reserves the right to modify, interpret, or apply this job description in any way the organization desires. This job description in no way implies that these are the only duties, including essential duties, to be performed by the employee occupying this position. Reasonable accommodations may be made to reasonably accommodate qualified individuals with disabilities. This job description is not an employment contract, implied or otherwise. The employment relationship remains "At-Will."

Odyssey Behavioral Healthcare