Appeals Specialist

We are seeking an Appeals Specialist to respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and required documentation to the state within the filing time limits. Act as a patient advocate by identifying the path needed to obtain the maximum reimbursement under the insurance plan and work with the patient to get the denial overturned.

Location: Middleburg Hts., Ohio – onsite for 1 month for training, then 100% remote

Pay: $18-20.00 per hour – based on experience

Shift: First

Direct Hire Permanent Opportunity

Job Responsibilities:

• Review assigned denials and EOBs for appeal filing information. Gather any missing information.
• Review case history, available documents, and payer history to determine appropriate appeal per client appeal strategy.
• Obtain patient and/or physician consent and medical records when required by the insurance plan.
• Gather and fill out all special appeal or review forms.
• Create appeal letters, attach the materials per client SOP, and send them for printing.
• Coordinate phone hearings with the insurance company, patient, and physician.
• Comply with all appeal process documentation and SOP’s.
• Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks.
• Report all insurance company requirement and denial trend changes to the team Supervisor and/or Manager.
• Participate in team and appeal meetings by sharing the details of cases worked.
• May undertake special projects assigned by the Production Supervisor or Manager.
• Ability to meet predetermined Productivity Goals based on the level of appeal.
• Ability to meet Quality Standard in place (90% or greater).
• Other duties as assigned.

Requirements:

• High School diploma or GED
• Minimum of four years health insurance billing experience
• Knowledge of managed care industry including payer structures, administrative rules, and government payers
• Proficient in all aspects of reimbursement
• Ability to maintain confidentiality
• Detail oriented
• Possess excellent written and verbal communication skills
• Able to establish priorities, work independently, and proceed with objectives without supervision.
• Proficient in using Microsoft Excel and Word

*We are looking for someone who can handle stress in a fast-paced environment with multiple priorities and deadlines while adapting to a changing atmosphere. The employee will be expected to make judgement decisions, grasp new ideas, and communicate with various employees and clients at all levels.