What are the responsibilities and job description for the Spec-Denials and Appeals PBR position at AlignMed Partners?
Overview
At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school.
With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent living facilities, outpatient clinics, and home-based care. We're proud to deliver personalized care exactly where and when it's needed most.
Join an industry-leading team that restores hope and makes a lasting impact. If you're passionate about making a meaningful difference and want to be part of the future of rehabilitation and wellness, Powerback is the place for you.
Why Powerback?
The Denials and Appeals Specialist is responsible for the follow up of denied claims from all commercial and contracted payers. The follow up includes initial assessment of the denials received to determine the appropriate process. Once determined, established policy and procedure will be followed for appeal submission.
Reviews assigned accounts that have a payer denial based on the response from the payer and takes appropriate action, including appeals, based on the type of denial.
Documents all necessary elements; reason for denial/audit, denial status, and action taken in the electronic medical record per denial management policy.
Provides missing or additional information if necessary, to expedite the resolution of the denied claim. This may include writing detailed appeal letters supporting the claim and reimbursement.
Performs all appeals and denials recovery procedures needed to appropriately and accurately resolve denied claims. This includes working with internal and external customers.
Consistently meets productivity and quality standards established by management, recommending new approaches for enhancing performance and productivity when appropriate.
Keeps Supervisor/Manager informed of any problems or issues related to the appeal process and/or current appeals.
Performs other duties as assigned.
Qualifications
At Powerback, we're on a mission to improve lives. As the leader in physical, occupational, speech, and respiratory therapies, we help older adults stay active and thrive while providing essential therapy for children at home and in school.
With over 38 years of trusted service, our reach spans skilled nursing centers, assisted and independent living facilities, outpatient clinics, and home-based care. We're proud to deliver personalized care exactly where and when it's needed most.
Join an industry-leading team that restores hope and makes a lasting impact. If you're passionate about making a meaningful difference and want to be part of the future of rehabilitation and wellness, Powerback is the place for you.
Why Powerback?
- Benefits: We offer Medical, Dental, and Vision plans to Full-Time and Part-Time team members.
- Support for New Grads & Clinical Fellows: Our Powerback Clinical Mentorship Program kicks off on day one, helping you learn from the best in the field.
- Continuing Education: Keep growing with free CEUs through Medbridge.
- H-1B Visa & Relocation Assistance: We support Visa or Green Card sponsorships, plus our Journey Travel Program lets you work across the U.S. with the security of a full-time role.
- Perks at Powerback: Enjoy exclusive discounts on Wireless/TV, Home/Auto/Renters and Pet Insurance, Childcare, Eldercare, and more. Earn rewards through our PowerZone Employee Recognition Program, and expand your expertise with our Clinicians in Action professional development program.
The Denials and Appeals Specialist is responsible for the follow up of denied claims from all commercial and contracted payers. The follow up includes initial assessment of the denials received to determine the appropriate process. Once determined, established policy and procedure will be followed for appeal submission.
Reviews assigned accounts that have a payer denial based on the response from the payer and takes appropriate action, including appeals, based on the type of denial.
Documents all necessary elements; reason for denial/audit, denial status, and action taken in the electronic medical record per denial management policy.
Provides missing or additional information if necessary, to expedite the resolution of the denied claim. This may include writing detailed appeal letters supporting the claim and reimbursement.
Performs all appeals and denials recovery procedures needed to appropriately and accurately resolve denied claims. This includes working with internal and external customers.
Consistently meets productivity and quality standards established by management, recommending new approaches for enhancing performance and productivity when appropriate.
Keeps Supervisor/Manager informed of any problems or issues related to the appeal process and/or current appeals.
Performs other duties as assigned.
Qualifications
- High School diploma or equivalent education and experience required. College degree preferred.
- Must be proficient using MS Office or Google Suite applications.
- Strong analytical skills.
- Minimum of 1 - 2 years of previous revenue cycle management experience.
