Denials and Appeals Representative

Essentials

• Reviews ETM task list assignment, comments, and rebills claim as necessary
• Reviews denials to determine appropriate action based on carrier requirements
• Assembles and forwards appropriate documentation to the senior representative for carrier related issues
• Reviews carrier provider manuals for billing updates as needed
• Reports any consistent errors found during review that affect claims from being processed correctly
• Participates in department meetings with Accounts Receivable Team
• Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
• Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager
• Completes charge corrections and adjustments as requested

Qualifications / Experience

• High school diploma or equivalent required
• 1+ year of medical billing experience preferred
• Knowledge of physician billing policies and procedures
• Computer literate
• Able to work in a fast-paced environment
• Adequate organizational skills
• Able to work independently