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Medical Billing-Revenue Cycle - Appeal Specialist
The Appeal Specialist supports the functions of the Revenue Cycle Appeal team by assisting in the review of denied and underpaid claims for the formal appeal and dispute process with the payor. Responsibilities include, but are not limited to: Classification of appeals, research of accounts, preparing documents, obtaining appeal status, and review of appeal determinations.
Essential Functions/Duties
Review Explanation of Benefits, denial letters and payor correspondence to classify type of appeal required.
Gather, prepare, and review documentation & various forms needed to submit appeals correctly per payor guidelines.
Engage patients via phone and/or mail to obtain requested information pertaining to the appeal process.
Document the details, requirements, and deadlines of each individual appeal in billing software.
Use reports to manage daily workflow and ensure accounts are processed within required timeframes.
Timely and regular follow-up with payors regarding status of appeals.
Ability to identify payor issues within the appeal process and discuss potential improvements and workflow solutions with leadership.
Additional duties as assigned.
Education:
High School diploma or equivalent
Skills:
Knowledge of health care billing procedures, reimbursement, third party payer regulations, documentation, and standards. Knowledge of Blue Cross Blue Shield payors is a plus
Understanding and interpretation of Explanation of Benefits (EOB) from payors
Strong problem-solving skills, attention to detail, and ability to make timely decisions
Excellent internal and external customer service skills
Responsiveness and a strong commitment to meeting internal and external deadlines with limited supervision
Qualifications:
Required Experience
Must be fluent in English
Minimum of one (1) year of advanced medical billing experience
Professional written and verbal communication skills
Knowledge and experience of computers and related technology
Ability to work independently with little or no direction and as a member of a team
Preferred (Not Required) Experience
Minimum of one (1) year working in a call center environment
Above average knowledge of insurance billing guidelines and policies
Experience with Commercial Insurance appeal and reconsideration processes
Experience with BCBS insurance a plus
Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing for individuals with a disability.
Check out our careers site to learn more about our benefit options.