What are the responsibilities and job description for the appeals specialist position at TMC Bonham Hospital?
Job Description
TMC Bonham Hospital is a state-of-the-art critical access hospital providing high-quality healthcare services to rural residents. With a focus on patient safety and quality care, our mission is to deliver the right care at the right time in the right setting.
About Us
We are managed by Texoma Medical Center, a subsidiary of UHS. Our Critical Access Hospital (CAH) Program was established to ensure access to healthcare services for rural residents, offering both inpatient and outpatient services, as well as 24-hour emergency services.
Responsibilities
The Appeals Specialist will be responsible for:
- Appealing all insurance denials in a timely and accurate manner
- Preparing reports on trends in denials
- Ensuring compliance with Managed Care contracts and government fee schedules
- Obtaining, manipulating, and analyzing data from various resources
Qualifications
To be successful in this role, you will need:
- Certification in medical coding and billing (preferred)
- 2-3 years of experience in customer service, healthcare appeals processing, or insurance industry
- A strong knowledge of clinical documentation, Medicare rules and regulations
- Excellent interpersonal communication and problem-solving skills
- Experience with Microsoft Office and internet websites
