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Job Requirements of Appeals Representative:
QUALIFICATIONS / EXPERIENCE:- High school diploma or equivalent required
- Previous medical billing experience preferred with primary emphasis on denial research and appeal processing
- Knowledge of Physician Billing Policies and Procedures across multiple states
- Excellent communication skills both oral and written
- Good computer skills with proficiency in Microsoft Outlook, Excel, Word, GE Centricity Business/ETM
- Ability to meet deadlines and work independently
- Ability to work overtime as needed
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Appeals Representative
TeamHealth
Akron, OH (Remote)
Full-Time
TeamHealth is named among the Top 150 Places to Work in Healthcare by Becker's Hospital Review. Newsweek Magazine recognizes TeamHealth as ‘one of the greatest workplaces for diversity, 2024’ and TeamHealth is also ranked as ‘The World’s Most Admired Companies’ by Fortune Magazine. TeamHealth, an established healthcare organization is physician-led and patient focused. We continue to grow across the U.S. from our Clinicians to Corporate Employees. Join us!
What we Offer:
*This is a remote, work-from-home position supporting the Akron, OH Billing Center*
JOB DESCRIPTION OVERVIEW:
ESSENTIAL DUTIES AND RESPONSIBILITIES:
What we Offer:
- Career Growth Opportunities
- Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
- 401K (Discretionary matching funds available)
- Generous PTO
- 8 Paid Holidays
- Equipment Provided for Remote Roles
*This is a remote, work-from-home position supporting the Akron, OH Billing Center*
JOB DESCRIPTION OVERVIEW:
- The Appeals Representative will review, organize, and monitor incoming payment denials, taking appropriate corrective action. The Analyst responds to carrier issues as needed and processes all appeals including Medicare, Medicaid, Blue Shield, and Commercial carriers.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Monitor and review all payment denials as assigned in Enterprise Task Manager and process these claims in the time frame assigned within the system
- Utilize the telephone and various carrier websites as research tools to expedite resolution for issues
- Assembles and forwards documentation to appeal disputed claims through Waystar
- Assist with research and development of appropriate denial procedures
- Contacts carriers to inquire on claims that have been denied and appealed
- Assembles and forwards appropriate documentation to the Senior Analyst for provider related issues
- Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting our claims
- Reports any consistent errors found during claims review that may affect claims from being processed correctly
- Consistently meet established completion times for projects and assignments
- Consistently meet and maintain the QA (95% or better) and designated production standards per sub-team
Job Requirements:
QUALIFICATIONS / EXPERIENCE:
- High school diploma or equivalent required
- Previous medical billing experience preferred with primary emphasis on denial research and appeal processing
- Knowledge of Physician Billing Policies and Procedures across multiple states
- Excellent communication skills both oral and written
- Good computer skills with proficiency in Microsoft Outlook, Excel, Word, GE Centricity Business/ETM
- Ability to meet deadlines and work independently
- Ability to work overtime as needed
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