What are the responsibilities and job description for the Appeals Specialist position at Medical Data Systems?
Medical Data Systems Inc. is seeking a detail-oriented and motivated Insurance Appeals Specialist to join our insurance support and billing team. The ideal candidate will demonstrate professionalism, independence, and a strong understanding of insurance processes while thriving in a fast-paced environment.
Key Responsibilities
Key Responsibilities
- Perform insurance follow-up activities, including claim submission, claim status inquiries, and filing appeals for denied claims.
- Process a high volume of detailed account information accurately and within established performance guidelines.
- Navigate multiple systems to obtain insurance, contact, and attorney information as needed.
- Support the prioritization of collections efforts by accurately updating account data and identifying next steps.
- Maintain the highest level of confidentiality and adhere to all HIPAA regulations.
- Apply hospital billing knowledge to carry out assigned duties efficiently.
- Complete insurance-related tasks such as correcting and resubmitting claims, filing appeals, and contacting insurance companies, attorneys, or patients regarding outstanding balances.
- Work assigned facility-specific queues, ensuring all accounts are updated with correct and complete information.
- Participate in special projects or assignments as directed.
- Assist colleagues and management by providing information or support related to insurance processes when needed.
- 3-5 years of experience in a healthcare setting such as a hospital business office, surgery center, physician practice, or health insurance organization.
- Strong communication skills, attention to detail, and self-motivation.
- Proficient knowledge of insurance processes, including claim submission, claim denials, HCPCS/CPT/ICD-10 coding basics, and claim status inquiries.
- Familiarity with Medicare/Medicaid, Commercial, Auto, Workers’ Compensation, Liability, Crime Victims, and State/Federal Insurance Programs.
- Experience with medical billing and collection practices, business office procedures, and multi-system computer navigation.
- Ability to type at least 55 words per minute.
- High School Diploma or GED required; some college preferred.
- Employment Type: Full-Time