Appeals Specialist - Patient Accounts - Full Time - Days

About the role

The Appeals Specialist will manage the organization’s third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines. This position will develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims. The Appeals Specialist will lead the organization’s denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials. The Appeals Specialist will work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports. The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.

Responsibilities

• Analyze, research and successfully appeal third party claims within timely filing timelines
• Develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims
• Lead the organization’s denials management process and make recommendations for continuous improvement
• Work closely with the Business Office Director and IT to build and refine payer variance and denial reports
• Provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams to prevent claim denials

Requirements

• High School Graduate or GED Equivalent required; relevant experience in lieu of High School Diploma/GED education will be considered
• Associate’s or Bachelor’s Degree in a Business related field highly preferred
• Foreign Medical Graduates welcome
• Minimum Work Experience: Three to five years of job related experience

Qualifications

• Must be computer literate
• Possess good verbal and written communication skills
• Excellent analytical skills

Skills

• Computer Literacy
• Verbal Communication
• Written Communication
• Analytical Skills

Benefits

Not specified

Pay

Not specified

Schedule

Not specified