- Process claims identified for appeals with appropriate documentation.
- Performs appeals follow-up duties on specific financial classifications, such as commercial insurance, self-pay, Medicare and Medicaid claims.
- Handles appeals and associated adjustments and charge corrections.
- Makes appeals follow-up calls to insurance companies to ensure timely processing of appeals.
- Reviews remittance advices for rejection and accuracy of payment amounts.
- Verifies accuracy and completeness of charge tickets, monitors attachments for appeals to obtain maximum reimbursements.
- Consistently meets the Quality Assurance (QA) standard as established within the department. Consistently meets the productivity and efficiency standards of working a set amount of appeals a day and follows best practices for one-touch resolution as established within the department. Acts as liaison between appeals/billing staff and the supervisor with finding resolutions to billing matters.
- Responds to questions and requests from insurance companies.
- Supports customer service unit in answering billing and appeals questions.
- Acts as back-up support for Accounts Receivable staff during peak times, vacations and illnesses.
Working Conditions
This position works remotely; however, occasional onsite presence may be required.
Preferred Qualifications
- Two years of college or business school.
- Working knowledge of computers, general office equipment, telephone console, medical terminology, collection techniques and communication skills that involves dealing with confidential information.
- Advanced knowledge of insurance policies, plans, and appeals process strongly preferred.
