What are the responsibilities and job description for the appeals specialist position at Southwest Healthcare System?
About Our Critical Access Hospital
TMC Bonham Hospital is a 25-bed critical access hospital that offers both primary care and specialty physician services, along with inpatient and outpatient care, and 24-hour emergency services.
The Critical Access Hospital Program was established to ensure access to healthcare services for rural residents, providing opportunities for service enhancement and quality of care improvement.
Our Mission is to deliver high-quality care and prioritize patient safety. We strive to provide the right care at the right time in the right setting every day.
We are committed to improving the quality of care we deliver on a daily basis.
Hospital Management - TMC Bonham is managed by Texoma Medical Center, a subsidiary of UHS.
Responsibilities of the Appeals Specialist
The Appeals Specialist is responsible for appealing all insurance denials and preparing relevant reports regarding trends in denials.
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 work with departmental personnel.
Requirements and Qualifications
- Certification in Medical Coding and Billing is preferred.
- A minimum of 2-3 years of experience in customer service, healthcare appeals processing, or the insurance industry.
- 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.
Why Work with Us? As part of our team, you will have the opportunity to make a difference in the lives of our patients and contribute to the success of our organization.
