The Appeals Clerk is a key component in the Revenue Cycle Management (RCM) process for Gordian Medical. Reporting directly to the Manager, Appeals and Audit, job functions include a multitude of clerical tasks to ensure files are complete and documented. Through this with the RCM and other departments, the goal involves ensuring the timeliness and accuracy of Audit and Appeal responses to payors and contractors.
The Appeals Clerk will support the Company and its subsidiaries by providing support to staff and management while exemplifying the company culture and operating with a high level of integrity.
Primary Responsibilities
:
· Reading and comprehending various Medicare and Medicare contractor documents (Redetermination/Reconsideration decisions/Audit Notices etc.)
· Understanding of the Medicare Appeals Process (timelines involved, documentation requirements etc.)
· Ability to meet daily deadlines imposed by Appeals and Audit timelines.
· Understanding our internal audit response process (timelines, programs involved, documentation requirements etc.)
· Alerting Appeals Assistant Manager of any irregularities or items of note in Medicare documentation being reviewed.
· Professional correspondence via email with Appeals management and staff regarding assignments.
· Heavy alpha-numeric data entry into excel/and Multiple CRM databases
· Ability to update multiple CRM system databases with specific data found on Medicare and Medicare contractor documentation.
· Assembly of documentation from multiple sources to be presented to requestor, filing and photocopying.
· Providing assistance in processing mail (opening letters, date stamp, sorting, etc.)
· Audit of internal documentation to comply with Medicare rules and regulations.
· Other duties as assigned.
Additional Responsibilities:
· Communicate regularly with the Management and Staff
· Attend meetings as required
· Attend continuing education courses when available
· Peer training
· Continuously work towards the Company’s goal and vision
· Other duties as directed by Manager
Education and Technical Skills:
· 1-2 years in a professional office environment
· High School graduate
· Proficient Microsoft Office skills, specifically Excel
Additional Eligibility Qualifications/Competencies:
· Detail oriented
· Good interpersonal, verbal, and written communication skills
· Excellent organization skills
· Ability to problem solve and work independently
· Strong data entry skills, 10 key proficient preferred
· Treats people with respect; keeps commitments; inspires the trust of others; works with integrity and principles; upholds organizational values.
· Reliable and contributing team member
Physical Requirements:
This position requires periods of time in which sitting, standing, use of hand and foot motion, vision, hearing, summarizing, focusing with frequent interruptions along with other physical, sensory and cognitive sensory functions are required.
Note: The above is intended to describe the general content of and requirements for the performance of this job. It is not construed as an exhaustive statement of duties, responsibilities or requirements and may change at any time
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All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. RestorixHealth is an EO employer – M/F/Veteran/Disability