Appeals Specialist

Job Summary

Under the direct supervision of the Business Office Director, the Appeals Specialist is responsible for providing follow-up on past due account receivables and management of claim rejections and appeals. Denial analysis by collecting denial data and providing charts, reports, and a drill-down to quickly and easily identify the root causes and financial impact of denials; appeal workflow to organize, prioritize, and monitor denial-related tasks to maximize revenue recovery; denial prevention to monitor hospital activities and initiate action-oriented workflows when problems are detected, well before they result in denials.

Licensure and Certification:

• N/A

Education:

• Minimum High School graduate or GED equivalent.

Experience:

• Three to five (3-5) years’ experience in a hospital, medical and/or related field
• Must have experience in primary claim follow-up, denial research, appeal filings, and training in medical reimbursement.

Knowledge and Skills:

• Computer experience mandatory.
• Organization skills
• Ability to communicate verbally and in writing, to be a self-starter, and demonstrate a pleasant voice and good public relations while performing duties.
• HMO/PPO and successful appeal process experience, minimum of 3 years.

• Customer service skills

   

Physical Demands – Clerical/Administrative Non-Patient Care:

·         Frequent sitting and standing/walking with frequent position change.

·         Continuous use of bilateral upper extremities in fine motor activities requiring fingering, grasping, and forward reaching between waist and chest level.

·         Occasional/intermittent reaching at or above shoulder level.

·         Occasional/intermittent bending, squatting, kneeling, pushing/pulling, twisting, and climbing.

·         Occasional/intermittent lifting and carrying objects/equipment weighing up to 25 pounds.

·         Continuous use of near vision, hearing and verbal communication skills in handling telephone calls, interacting with customers and co-workers and performing job duties.