Appeals Specialist
$39,520–$43,680 year
HybridMiddleburg Heights, Ohio, United States
Job Summary
Review assigned denials and EOBs to gather missing information and determine appeal strategies based on case history and state requirements. Obtain patient and physician consent, fill out special forms, and create appeal letters with attached materials to submit within strict filing time limits. Coordinate phone hearings with insurers, patients, and physicians while complying with all first, second, third, and external level appeal SOPs. Report denial trend changes to management and participate in team meetings to share case details. Act as a backup for incoming telephone calls and undertake special projects as assigned. Complete assigned worklist tasks timely to meet productivity goals and quality standards exceeding 90%.
Required Qualifications
- High School diploma or GED
- Minimum of four years health insurance billing experience
- Knowledge of managed care industry including payer structures, administrative rules, and government payers
- Proficient in all aspects of reimbursement
- Ability to maintain confidentiality
- Detail oriented
- Possess excellent written and verbal communication skills
- Able to establish priorities, work independently, and proceed with objectives without supervision
- Proficient in using Microsoft Excel and Word
- Training period requires you working onsite 5 days/week for 3 months at our Middleburg Heights, OH or Milan, OH facilities before transitioning to remote
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