Appeals Representative

3 weeks ago

Louisville TN, United States TeamHealth Full time

Join a team of dynamic, results oriented professionals

Named among “The World’s Most Admired Companies" by Fortune Magazine
Named among "America's 100 Most Trustworthy Companies" by Forbes magazine
Named among “Great Places to Work" by Becker’s Hospital Review

  • Career Growth Opportunities
  • Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
  • 401K program (Discretionary matching funds available)
  • Employee Assistance Program
  • Referral Program
  • Dental plans & Vision plans
  • GENEROUS Personal time off
  • Eight Paid Holidays per year
  • Quarterly incentive plans
  • Employee of the month awards with monetary gift and parking space
  • Training Programs
  • Fitness Center with personal trainer on site
  • Wellness programs
  • Flexible work schedule

JOB DESCRIPTION OVERVIEW:

Position is responsible for reviewing denials assigned to Appeals Role in ETM System and processing appeal from Waystar Appeal system.

Maintains accuracy and production to ensure denials are being processed efficiently. Responsibilities of position includes, but not limited to the following:

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Reviews ETM list to identify trends and carrier issues that need to be reported to management.
  • Reviews ETM appeal role denials to determine appropriate action based on carrier requirements.
  • Assembles and prepares documentation in Waystar system to carrier to appeal disputed claims.
  • Assembles, prepares and forwards documentation on Medicaid CA and WC to appeal disputed claims.
  • Handles correspondence related to Medicare, Medicaid, Blue Cross Blue Shield, Managed Care and Tenncare according to written procedure.
  • Assembles and forwards appropriate documentation to the Senior Representative for provider related issues.
  • Maintain knowledge of carrier requirements for appeal completion.
  • Maintain knowledge of ETM system.
  • Maintain knowledge of Waystar appeals processes.
  • Report any consistent errors found during review that affect claims from being processed correctly.
  • Participates in monthly meeting with Appeals Supervisor.
  • Turns to Supervisor for unusual circumstances that may include write-offs, denials, fee schedules, claims, etc.
  • Performs any and all duties as directed by Senior Representative, Appeals Supervisor and Accounts Receivable Manager.



QUALIFICATIONS / EXPERIENCE:

  • Demonstrated knowledge of physician billing.
  • Demonstrated knowledge of health care reimbursement guidelines.
  • Knowledge of ICD-10 and CPT-4 coding.
  • Excellent oral and written communication.
  • Detailed in completing Appeal documentation.
  • Knowledge of appeals and review policies for all plans.
  • Thorough working knowledge of physician billing policies and procedures.
  • Computer literate.
  • Excellent follow-up skills.
  • Excellent organizational skills.
  • High school diploma or equivalent.
  • Minimum two years previous medical billing experience preferred with emphasis on research and claim denials in Accounts Receivable.
  • Training classes and seminar attendance may require travel.

SUPERVISORY RESPONSIBILITIES:

  • None

PHYSICAL / ENVIRONMENTAL DEMANDS:

This job will be performed in a well-lighted and well-vented environment. Work is oriented around good visual skills. Eye fatigue may be encountered as extended amount of time is spent in front of computer.

This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week.

Overtime may be required and can be mandated by Management.

DISCLAIMER:

Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.

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