Appeals Specialist

2 weeks ago

Houston, United States Henry Mayo Newhall Hospital Full time

Job SummaryUnder the direct supervision of the Business Office Director, the Appeals Specialist is responsible for providing follow-up on past due account receivables and management of claim rejections and appeals. Denial analysis by collecting denial data and providing charts, reports, and a drill-down to quickly and easily identify the root causes and financial impact of denials; appeal workflow to organize, prioritize, and monitor denial-related tasks to maximize revenue recovery; denial prevention to monitor hospital activities and initiate action-oriented workflows when problems are detected, well before they result in denials.Licensure and Certification:N/AEducation:Minimum High School graduate or GED equivalent.Experience:Three to five (3-5) years’ experience in a hospital, medical and/or related fieldMust have experience in primary claim follow-up, denial research, appeal filings, and training in medical reimbursement.Knowledge and Skills:Computer experience mandatory.Organization skillsAbility to communicate verbally and in writing, to be a self-starter, and demonstrate a pleasant voice and good public relations while performing duties.HMO/PPO and successful appeal process experience, minimum of 3 years.Customer service skillsPhysical Demands – Clerical/Administrative Non-Patient Care:·Frequent sitting and standing/walking with frequent position change.·Continuous use of bilateral upper extremities in fine motor activities requiring fingering, grasping, and forward reaching between waist and chest level.·Occasional/intermittent reaching at or above shoulder level.·Occasional/intermittent bending, squatting, kneeling, pushing/pulling, twisting, and climbing.·Occasional/intermittent lifting and carrying objects/equipment weighing up to 25 pounds.·Continuous use of near vision, hearing and verbal communication skills in handling telephone calls, interacting with customers and co-workers and performing job duties.Key for Physical DemandsContinuous66 to 100% of the timeFrequent33 to 65% of the timeOccasional0 to 32% of the time

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