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Job description
Appeals SpecialistThe Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.Duties and responsibilities include:Reviews and appeal unpaid and denied claimsAttaches appropriate documents to appeal lettersResearches and evaluates insurance payments and correspondence for accuracyLogs appeals and grievances, and tracks progress of claimsKeeps up-to-date reports and notates any trends pertaining to insurance denialsCalls insurance companies to inquire about claims, refund requests and paymentsManages Accounts Receivable reports for the Billing DepartmentUtilizes EMR system to submit and correct claimsPosts patient and insurance paymentsSends paper claims to insurance carriersAnswers patient billing questionsCoordinates medical and billing records payments with patients and/or third-party payersHandles collections on unpaid accountsIdentifies and resolves patient billing complaintsAnswers phone calls to the Billing Department in a timely and professional mannerProcesses credit card payments over the phone and in personServes and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirementsEnhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishmentsOperates standard office equipment (e.g. copier, personal computer, fax, etc.)Has regular and predictable attendanceAdheres to Advanced Pain Care's Policies and proceduresPerforms other duties as assignedRequirements:QualificationsEducation: Requires a high school diploma or GEDExperience: Three or more years related work experience with medical billing/claimsPrevious use of Athena requiredKnowledge, Skills and Abilities:Clear and precise communicationAbility to pay close attention to detailEffectively manages day by organizing and prioritizingPossesses excellent phone and customer service skills and abilitiesProtects patient information and maintains confidentialityKnowledge of general medical terminology, CPT, ICD-9 and ICD-10 codingFamiliarity with analyzing electronic remittance advice and electronic fund transfersExperience interpreting zero pays and insurance denialsCompetence in answering patient questions and concerns about billing statementsOrganizational skills and ability to identify, analyze and solve problemsWorks well independently as well as with a teamStrong written and verbal communication skillsInterpersonal/human relations skillsWorking conditionsEnvironmental Conditions: Medical Office environmentPhysical Conditions:Must be able to work as scheduled – typically from 8:00 – 5:00 M-FMust be able to sit and/or stand for prolonged periods of timeMust be able to bend, stoop and stretchMust be able to lift and move boxes and other items weighing up to 30 pounds.Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.
Worksite address
austin, TX, 78701, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.