Description

Job purpose

• The 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

• Reviews and appeal unpaid and denied claims
• Attaches appropriate documents to appeal letters
• Researches and evaluates insurance payments and correspondence for accuracy
• Logs appeals and grievances, and tracks progress of claims
• Keeps up-to-date reports and notates any trends pertaining to insurance denials
• Calls insurance companies to inquire about claims, refund requests and payments
• Manages Accounts Receivable reports for the Billing Department
• Utilizes EMR system to submit and correct claims
• Posts patient and insurance payments
• Sends paper claims to insurance carriers
• Answers patient billing questions
• Coordinates medical and billing records payments with patients and/or third-party payers
• Handles collections on unpaid accounts
• Identifies and resolves patient billing complaints
• Answers phone calls to the Billing Department in a timely and professional manner
• Processes credit card payments over the phone and in person
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
• Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
• Has regular and predictable attendance
• Adheres to Advanced Pain Care’s Policies and procedures
• Performs other duties as assigned

Requirements

Qualifications

Education: Requires a high school diploma or GED

Experience: Three or more years related work experience of training

Knowledge, Skills and Abilities:

• Clear and precise communication
• Ability to pay close attention to detail
• Effectively manages day by organizing and prioritizing
• Possesses excellent phone and customer service skills and abilities
• Protects patient information and maintains confidentiality
• Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
• Familiarity with analyzing electronic remittance advice and electronic fund transfers
• Experience interpreting zero pays and insurance denials
• Competence in answering patient questions and concerns about billing statements
• Organizational skills and ability to identify, analyze and solve problems
• Works well independently as well as with a team
• Strong written and verbal communication skills
• Interpersonal/human relations skills

Working conditions

Environmental Conditions: Medical Office environment

Physical Conditions:

• Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
• Must be able to sit and/or stand for prolonged periods of time
• Must be able to bend, stoop and stretch
• Must 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.