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Healthcare Appeals Professional

2 months ago

Addison, Texas, United States TEKsystems Full time
Job Overview

We are seeking a highly skilled Medical Claims/Appeals Specialist to join our team at TEKsystems. As a key member of our organization, you will play a critical role in ensuring timely and accurate submissions of denied or underpaid claims.

Key Responsibilities:

  • Review and analyze denied claims, payment discrepancies, and reimbursement issues to identify root causes.
  • Initiate and manage the appeals and arbitration process for denied or underpaid claims.
  • Prepare compelling appeal letters, supporting documentation, and necessary forms to present a strong case for claim reconsideration.
  • Stay up-to-date with payer policies, regulations, and industry trends related to claim appeals and arbitration.
  • Maintain a comprehensive understanding of coding guidelines, medical necessity, and reimbursement methodologies to strengthen appeal arguments.
  • Develop and maintain strong relationships with payers, providers, and other stakeholders to ensure seamless claim processing.

Requirements:

  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal skills.
  • Ability to work in a fast-paced environment and meet deadlines.
  • Proficiency in medical coding and reimbursement methodologies.
  • Knowledge of payer policies and regulations.

About TEKsystems:

We are a leading provider of technology services and talent solutions, partnering with clients to drive transformation and growth. Our team of experts works with clients across various industries to deliver innovative solutions and drive business results.