Insurance Appeals Specialist

This position is responsible for corresponding with both commercial and government health insurance payers to address and resolve outstanding insurance balances and coding denials in accordance with established guidelines and requirements.

This position also conducts follow-up activities through phone calls, online processing, fax and written correspondence.

Position must be able to communicate effectively with payer representatives in order to support denial resolutions.

Under general direction, this position:

• Collaborates with Physicians, Practice Managers, and other Practice support staff
• Manages account receivables and appeals
• Collects patient payments
• Accurately and completely performs AR follow-up on denied claims
• Submits appeals in a timely manner
• Utilizes customer service support skills - both verbal and written correspondence with insurance payers, physician practices and patients; answer phones, process payments, assist patients and physician practices, and insurance companies with billing questions.

Minimum Requirements:

• High School Diploma or equivalent required
• Knowledge of Commercial and Government Insurance Plans, and Insurance verification skills
• Computer experience – Intermediate or above preferred (Microsoft Word, Excel, EHR/PM Systems).
• Three (3) years of recent medical billing experience preferred.
• Knowledge of CPT and ICD-10 Codes
• Ability to read and evaluate eligibility / benefits responses and EOB’s

Skills Required:

Typing, filing, sitting for long periods of time, critical thinking, time management, problem resolution, and the ability to work in a fast-paced environment.

Working Conditions:

• Business office environment, casual dress code
• Benefits; health, dental, vision, and more
• Full-Time; 8 hours Shifts

Onsite position in Huntsville, AL

Experience:

• ICD-10: 1 year (Required)

Job Summary:

Understand and communicate contract specific issues related to the resolution of disputed payments, for a variety of payers such as Workman’s Compensation, Tricare, the VA, and Commercial Payors. Maintain established departmental policies and procedures, objectives, patient, and customer service policies. Handle difficult patient and third-party follow-up problems. Review accounts recommended for write-off to ensure accounts have aged as determined by corporate/guidelines. Assist team members with questions, concerns, and complaints from insurance companies, patients, and other personnel. Establish positive working relationships with individuals at insurance companies, and within the TOC workplace in order to facilitate thorough appeals.

Responsibilities:

Analytical and technical skills within areas listed in the “Job Summary” section above. Identify coding or billing problems from EOBs and work to correct the errors in a timely manner. Work with insurance carriers to secure payment on outstanding account balances. Oversee the activities related to appeals/denials, ensuring processes are performed efficiently and effectively. Mandatory root cause analysis of denials to understand trends to decrease new denials and final write off denials by identifying operational opportunities that will decrease denials overall. Monitoring trends and communicating with Leadership. Must demonstrate strong commitment to stakeholder relationships by taking ownership of issues and facilitating effective outcomes in a timely manner. Clear and concise written and verbal communication skills.