Appeals Assistant

Qualifications

• High School Diploma; Associate’s degree or equivalent experience in health care, conflict resolution, or related field preferred.
• A minimum of 1 year of experience in a medical office setting is recommended.
• Valid driver’s license and auto insurance.

Functions and Responsibilities

• Under the direction of the assigned supervisor, perform a variety of clerical duties pertaining to the compliance and appeals department.
• Participate in chart reviews and audits.
• Maintain a current knowledge of federal and state regulations, as well as payer specific requirements and take appropriate action as appropriate.
• Manage the receipt, investigation, and resolution of appeals in a timely, compliant, and highly effective manner.
• Receives and performs research on appeals and categorizes each appeal appropriately.
• Communicate with providers in a professional manner, and clearly articulate what information is required for processing appeals.
• Completes data entry and documentation requirements in multiple systems: including correct input of audit universe fields.
• Coincides with internal departments and external vendors relative to the investigation, review, and resolution of an appeal and the research needed to prepare the case for internal and external review.
• Interacts with Managers, Medical Directors, Executive Directors, Case Managers, Legal, Finance, and other areas in facilitating identification and resolution of appeals.
• Assists with the inner office departments including medical records, human resources, Quality Assurance, or front desk as needed.
• Performs clerical, administrative, and secretarial responsibilities and tasks within the office.
• Monitor, transfer, and guide all telephonic communications to needed departments.
• Allocates resources to enable task performance.
• Opens, distributes, and manages the mail as needed.
• Maintains a clean office work environment, including wiping down counters, doors, and taking out trash if necessary.
• Designs, implements, and ensures that the policies and procedures are created and are adhered to.
• Maintains a safe and secure working environment.
• Fax, records, and monitors paperwork that is faxed in and out of the office.