Appeals Resolution Professional
2 weeks ago
About the Role
We are committed to providing high-quality healthcare services to our clients, and we need a skilled Managed Care Appeals Representative to help us achieve this goal. In this role, you will be responsible for reviewing and resolving insurance claims that have been denied or disputed by insurance carriers. You will also manage and process medication prior authorizations to ensure timely and efficient medication administration.
Key Responsibilities
- Review and analyze claim denials to perform the appropriate appeals necessary for reimbursement.
- Obtain necessary medical documentation needed for appeal submission.
- Submit written appeals to insurance carriers and follow up on the status of submitted appeals.
- Document and create reports of all appeal activity in appropriate systems and maintain organized records of all appeals.
- Collaborate with Utilization Review and Patient Accounts to resolve any authorization issues.
- Stay current with payor authorization requirements such as time frames.
- Provide excellent customer service to patients, healthcare providers, and insurance carriers.
Requirements
- A bachelor's degree in a relevant field such as Healthcare, Nursing, Performance, Law, Business, Management or Health.
- RN or LPN preferred with Behavioral Health experience.
- Ability to receive and maintain a Level II Background clearance.
- Acceptable Motor Vehicle Registration driver's license record in accordance with the underwriting guidelines set by Aspire insurance company.
- Ability to multitask, prioritize tasks and meet deadlines.
- Ability to learn and utilize the EHR system.
- Must be able to prioritize workload; plan, organize, and coordinate appropriate workload in conjunction with other team members.
- Have strong analytical/deductive, mathematical analysis and problem-solving skills.
- Ability to work independently and effectively under pressure to meet deadlines.
- Flexible and willing to perform other tasks as assigned.
- 3+ years of experience initiating appeals with Managed Care or Commercial Payors for reimbursement.
- Utilization and/or Case Management experience recommended.
- Proficient in data manipulation and spreadsheet development including pivot tables using Microsoft Excel and other Microsoft Office products.
- Strong communication skills, both verbal and written.
- Ability to communicate effectively and professionally, verbally and written, with external/internal clients.
- Strong knowledge of medical terminology, coding systems (ICD-9, ICD-10), and managed care guidelines.
- Understand managed care insurance products and their financial impacts on payors and providers.
Salary Range
$65,000 - $85,000 per year, depending on experience.
Benefits
- Medical, dental, vision, basic life, and supplemental insurance.
- Flexible spending accounts.
- Paid time off (2.5 weeks per year).
- Diversity and floating holidays.
- Paid holidays (6 days per year).
- 403(b) retirement plan with 50% employer match.
- Employee discounts.
About Aspire Health Partners
Aspire Health Partners is a leading non-profit behavioral health organization in the Southeast. For over fifty years, we have provided comprehensive and compassionate care to individuals, families, and communities. Our mission is to provide the highest quality of integrated behavioral healthcare, and we are committed to making a positive impact in the lives of those we serve.
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