Claim Appeals Specialist
3 weeks ago
The Claim Appeals Specialist is responsible for researching and addressing claim issues related to medical necessity in which a request for additional information or denial of payment has been received. This position works closely with payers and our Billing and Collections teams to effectively address the denial/request for additional information with supporting clinical information and persuasive writing in effort to secure reimbursement.
Responsibilities:
Utilize resources to effectively research denial/requests for additional information
Evaluate clinical information and supportive documentation prior to payer response
Prepare persuasive response to request for information or appeal based on supporting clinical information and available studies/research
Prepare clear and concise persuasive statements of medical necessity from a clinician’s perspective
Monitor denial and appeals information for payor, provider or departmental trends. Routinely report to management regarding trends and recommends process improvement initiatives.
Generate denial and appeal tracking reports for management and departments
Maintain compliance with all appropriate regulatory requirements including HIPAA
Other duties and projects as assigned
Qualifications:
Education & Experience
Required:
Bachelor’s degree or equivalent relevant work experience
1-3 years’ experience writing commercial payer claim appeals
1+ years of commercial billing experience
Preferred:
Clinical background
Previous experience in medical device industry or health insurance
Experience with Brightree software
Knowledge & Skills
Experience with Microsoft Word, Excel, and Outlook
Understanding of health insurance methodologies (coding, coverage, prior authorizations, clinical criteria and payments)
Exceptional attention to detail and written communications skills with emphasis on persuasion and clinical knowledge
Excellent analytical and research skills
Strong strategic thinking ability with bias towards action/execution
Ability to organize and manage workload with limited oversight
Below is the starting salary range for this position, although offers may differ based on the candidate's location, job-specific knowledge, skills and experience.:
$23.41 - $30.69 / HR
Additional benefits::
Non-Exempt - Our total compensation package includes medical, dental and vision benefits, retirement benefits, employee stock purchase plan, paid time off, parental leave, family medical leave, volunteer time off and additional leave programs, life insurance, disability coverage, and other life and work wellness benefits and discounts. Benefits may be subject to generally applicable eligibility, waiting period, contributions, and other requirements and conditions.
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