Medical Billing

Found in: Resume Library US A2 - 2 weeks ago


West Plains Missouri, United States Air Evac Lifeteam Full time
More Information about this Job:
IMMEDIATE OPENING 

 

 

Medical Billing-Revenue Cycle – Appeal Specialist  

 

The Appeal Specialist supports the functions of the Revenue Cycle Appeal team by assisting in the review of denied and underpaid claims for the formal appeal and dispute process with the payor. Responsibilities include, but are not limited to: Classification of appeals, research of accounts, preparing documents, obtaining appeal status, and review of appeal determinations.  

Essential Functions/Duties 

Review Explanation of Benefits, denial letters and payor correspondence to classify type of appeal required.  

Gather, prepare, and review documentation & various forms needed to submit appeals correctly per payor guidelines. 

Engage patients via phone and/or mail to obtain requested information pertaining to the appeal process. 

Document the details, requirements, and deadlines of each individual appeal in billing software. 

Use reports to manage daily workflow and ensure accounts are processed within required timeframes.  

Timely and regular follow-up with payors regarding status of appeals.  

Ability to identify payor issues within the appeal process and discuss potential improvements and workflow solutions with leadership. 

Additional duties as assigned. 

 Education: 

High School diploma or equivalent  

 Skills: 

Knowledge of health care billing procedures, reimbursement, third party payer regulations, documentation, and standards. Knowledge of Blue Cross Blue Shield payors is a plus 

Understanding and interpretation of Explanation of Benefits (EOB) from payors 

Strong problem-solving skills, attention to detail, and ability to make timely decisions 

Excellent internal and external customer service skills 

Responsiveness and a strong commitment to meeting internal and external deadlines with limited supervision  

 

Qualifications: 

Required Experience  

Must be fluent in English 

Minimum of one (1) year of advanced medical billing experience 

Professional written and verbal communication skills 

Knowledge and experience of computers and related technology 

Ability to work independently with little or no direction and as a member of a team 

Preferred (Not Required) Experience  

Minimum of one (1) year working in a call center environment 

Above average knowledge of insurance billing guidelines and policies 

Experience with Commercial Insurance appeal and reconsideration processes 

Experience with BCBS insurance a plus 

EEO Statement:
Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing for individuals with a disability.

More Information about this Job:
Check out our careers site  to learn more about our benefit options.


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