The Accounts Receivable Appeals Specialist is responsible for ensuring accuracy and compliance for healthcare professional Workers’ Comp claims, reviewing processed payments, and collecting on delinquent accounts. Maintains databases and audits patient charts and billing information for accurate processing of claims. Analyze, identify, and resolve billing issues causing payment delays. Research and resolve patient, provider and insurance company concerns in a timely manner. Must have experience in billing with claim follow ups, checking the status for unpaid claims, submitting corrected claims, and filing appeals.

Essential Duties and Responsibilities

• Review Posted payments to applicable system and maintains Explanation of Review records as necessary.

• Obtain Explanation of Review documentation and proof of payment records as necessary

• Maintain a record of PPO discount names and rates.

• Submit Second Bill Reviews, Corrected claims, and Appeals.

• Verification of appropriate Requests for Authorizations (RFA).

• Sort correspondences and other letters and routes to the most appropriate recipients as applicable

• Communicate effectively with claims administrators and adjusters to submit necessary documentation for payment of claims.

• Maintain positive working relationships with claims administrators, adjusters, clients, and other key stakeholders.

• Coordinate the completion of outstanding reports and other documentation within the medical record as necessary for collections. Submits necessary documentation for payment of claims.

• Verify completeness and accuracy of medical records and charges prior to submitting a Second Bill Review or Appeal

• Review documentation and performs audits to determine billing accuracy and gaps.

• Responsible for documenting all correspondences and phone conversations regarding medical claims and other bills.

• Works various assigned tasks in billing system.

• Comply with applicable HIPAA policies and procedures.

• Assist with assigned projects that pertain to billing under the direction of the Billing and Collections Supervisor/Manager

• Excellent Customer Service

• Problem-Solving Skills

• Detail Oriented

• Strong written and verbal communication skills

• Collaboration Skills

• Ethical Conduct

• Thoroughness

Education, Licenses/Certification

• At least 2 years of experience Collecting on occupational medicine Workers Compensation Claims.

• Experience in Appealing Department of Labor (DOL) Workers Compensation Claims a plus.

• Knowledge of ICD-10, CPT, HCPCS, and modifier codes, CMS-1500 forms

• Experience with billing for employer services

• Experience working with adjusters and healthcare insurance companies.

• Knowledge of Workers’ Compensation claims collections and checking the status of unpaid claims, submitting corrected bills, and filing appeals

• Knowledge of basic office equipment software: Windows, Microsoft office, Excel, Familiar with PrognoCIS EMR a plus etc.

Preferred Qualifications

• Certification in Medical Billing and Coding Preferred or equivalent work experience.

• Knowledge of Medical terminology

• Experience in Occupational Medicine Worker’s Compensation

This job description may not include all the duties assigned to the employee and may be updated and modified by the department supervisor, according to the operations at any given time.

The base salary is determined on the candidate's education, qualifications, and experience, and is subject to change based on various internal and external factors.

Akeso is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.