Senior Appeals Representative

3 weeks ago

Knoxville, Tennessee, United States TeamHealth Full time
Job Title: Senior Appeals Representative

At TeamHealth, we're committed to delivering exceptional patient care and providing a supportive work environment for our team members. As a Senior Appeals Representative, you'll play a critical role in ensuring the accuracy and production of our appeals department.

Job Summary:

The Senior Appeals Representative is responsible for maintaining accuracy and production for the department, overseeing daily functions of employees, and training department staff. This role provides leadership and guidance to Representatives in the Appeals and Provider Enrollment Research Roles.

Key Responsibilities:
  • Reviews ETM PIT reports daily to provide guidance to employees on effectively organizing and working assignments.
  • Provides training to new staff, as well as, in-service training of established staff.
  • Reviews invoices to determine appropriate action based on carrier requirements.
  • Assembles and forwards documentation to appeal disputed claims.
  • Reports any consistent errors found that affects claims from being processed correctly.
  • Participates in departmental meetings.
  • Reviews and appeals claims that have been denied and that appropriately require intervention.
  • Communicates with Supervisor and/or AR Manager to keep them informed of any detected problems or changes in AR.
  • Performs any and all duties as directed by the Supervisor, and/or Account Receivables Manager.
  • Performs quality audits on Appeals/Provider Enrollment Research staff members.
  • Assists with research and development of appropriate appeal/provider enrollment research.
  • Creates and updates policy and procedures for department.
  • Researches denials to determine if claim issue and/or provider issue exists and forwards to the appropriate department for correction.
Requirements:
  • Minimum two years previous medical billing experience required with emphasis on research and claim denials in Accounts Receivable.
  • Demonstrated knowledge of physician billing.
  • Demonstrated knowledge of health care reimbursement guidelines especially Medicare and Medicaid.
  • Knowledge of ICD-9, ICD-10 and CPT-4 coding.
  • Good oral and written communication.
  • Knowledge of appeals and reviewing policies for state and government plans.
  • Thorough working knowledge of physician billing policies and procedures.
  • Computer literate.
  • Excellent follow-up skills.
  • Excellent organizational skills.
  • Knowledge of Microsoft Office applications such as Excel and Word.
Education:

High school diploma or equivalent.

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