Appeals Administrator

4 weeks ago

Franklin, United States XSOLIS, Inc. Full time

At XSOLIS, the Appeals Admin work with our clients and client representatives to investigate denied claims, document investigation, and work to effect reimbursement for denied services. The Appeals Analyst will need a strong understanding of clinical policies, contracts, and regulations to guide research into claim denials. Aside from the technical know-how, a successful Appeals Analyst will also have the soft-skills necessary to build relationships with clients, payers, and providers and the ability to draft a convincing argument for reimbursement.

Essential Duties & Responsibilities

The essential functions include, but are not limited to the following:

Ability to resolve claims by reviewing supporting documentation; calculating benefits due; initiating payment or composing appeal letters; guiding resolution of non-routine claims; auditing claims to ensure appropriate payment.

Ability to maneuver through multiple facility patient accounting systems

Assists in creating reports by securing analytical information through to a finished product

Work with Appeals Analysts to analyze claims to determine validity of denial/recovery options from client inventories and formulate recovery resolution

Clearly and concisely document all actions taken to resolution within a claims recovery system

Provide support to the Appeals team

Familiarity with Microsoft Office products, Access, provider and payer operating systems a plus.

Minimum Qualifications (Knowledge, Skills, and Abilities)

Superior verbal, written, customer service, and analytical skills

Well versed in MS Office Products specifically with Excel advanced proficiency.

Knowledge of reimbursement solutions

Good negotiating skills with problem recognition and resolution skills

Ability to effectively drive several tasks/roles at any given point

Ensures legal compliance by following guidelines, contracts, regulations, and the company's business plan

Maintains quality service by following corporate provider and payer service practices and protocols.

Ability to multi-task and work in a team environment

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