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Job Requirements of Appeals Representative (Remote):
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
DISCLAIMER:
Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.
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Appeals Representative (Remote)
TeamHealth is named among the “150 Great Places to Work in Healthcare” by Becker’s Hospital Review and has ranked three years running as “The World’s Most Admired Companies” by FORTUNE Magazine as well as one of America’s 100 Must Trustworthy Companies by Forbes Magazine in past years. TeamHealth, an established healthcare organizations is physician-led and patient-focused. We continue to grow across the U.S. from our Clinicians to our Corporate Employees and we want you to join us.
- Career Growth Opportunities
- Benefit Eligibility (Medical/Dental/Vision/Life) the first of the month following 30 days of employment
- 401K program (Discretionary matching funds available)
- GENEROUS Personal time off
- Eight Paid Holidays per year
- Quarterly incentive plans
*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
DISCLAIMER:
Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.