What are the responsibilities and job description for the appeals specialist position at Foundations for Living?
Responsibilities
At TMC Bonham Hospital, a 25-bed critical access hospital, our core mission is to deliver the right care at the right time in the right setting. We are committed to improving the quality of care we provide every day.
The Appeals Specialist plays a crucial role in appealing all insurance denials and preparing reports on trends in denials. To achieve this, the specialist must demonstrate the ability to ensure accurate and timely appeals to third-party payers in compliance with Managed Care contracts and government fee schedules.
The Appeals Specialist will obtain, manipulate, and analyze data from various resources, including hospital/physician billing systems, external contract/claims management, and collaborate with departmental personnel.
Qualifications
Certification in medical coding and billing is preferred.
2-3 years of experience in customer service, healthcare appeals processing, or the insurance industry
The ideal candidate should possess a strong knowledge of clinical documentation, Medicare rules and regulations; excellent interpersonal communication and problem-solving skills to gather and exchange data with key medical and third-party professionals; experience with Microsoft Office and internet websites.
EEO Statement
TMC Bonham Hospital is an equal opportunity employer and as such, openly supports and fully commits to recruitment, selection, placement, promotion, and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
At TMC Bonham Hospital, a 25-bed critical access hospital, our core mission is to deliver the right care at the right time in the right setting. We are committed to improving the quality of care we provide every day.
The Appeals Specialist plays a crucial role in appealing all insurance denials and preparing reports on trends in denials. To achieve this, the specialist must demonstrate the ability to ensure accurate and timely appeals to third-party payers in compliance with Managed Care contracts and government fee schedules.
The Appeals Specialist will obtain, manipulate, and analyze data from various resources, including hospital/physician billing systems, external contract/claims management, and collaborate with departmental personnel.
Qualifications
Certification in medical coding and billing is preferred.
2-3 years of experience in customer service, healthcare appeals processing, or the insurance industry
The ideal candidate should possess a strong knowledge of clinical documentation, Medicare rules and regulations; excellent interpersonal communication and problem-solving skills to gather and exchange data with key medical and third-party professionals; experience with Microsoft Office and internet websites.
EEO Statement
TMC Bonham Hospital is an equal opportunity employer and as such, openly supports and fully commits to recruitment, selection, placement, promotion, and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status, or any other characteristic protected by federal, state, or local laws.
