Description
REMOTE - this position will be fully remote after training. **Texas residents only***
Job purpose
- The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.
Duties and responsibilities
- Reviews and appeal unpaid and denied claims
- Attaches appropriate documents to appeal letters
- Researches and evaluates insurance payments and correspondence for accuracy
- Logs appeals and grievances, and tracks progress of claims
- Keeps up-to-date reports and notates any trends pertaining to insurance denials
- Calls insurance companies to inquire about claims, refund requests and payments
- Manages Accounts Receivable reports for the Billing Department
- Utilizes EMR system to submit and correct claims
- Posts patient and insurance payments
- Sends paper claims to insurance carriers
- Answers patient billing questions
- Coordinates medical and billing records payments with patients and/or third-party payers
- Handles collections on unpaid accounts
- Identifies and resolves patient billing complaints
- Answers phone calls to the Billing Department in a timely and professional manner
- Processes credit card payments over the phone and in person
- Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
- Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
- Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
- Has regular and predictable attendance
- Adheres to Advanced Pain Care’s Policies and procedures
- Performs other duties as assigned
Requirements
Qualifications
Education: Requires a high school diploma or GED
Experience:
Three or more years related work experience with medical billing/ claims
Previous use of Athena required
Knowledge, Skills and Abilities:
- Clear and precise communication
- Ability to pay close attention to detail
- Effectively manages day by organizing and prioritizing
- Possesses excellent phone and customer service skills and abilities
- Protects patient information and maintains confidentiality
- Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
- Familiarity with analyzing electronic remittance advice and electronic fund transfers
- Experience interpreting zero pays and insurance denials
- Competence in answering patient questions and concerns about billing statements
- Organizational skills and ability to identify, analyze and solve problems
- Works well independently as well as with a team
- Strong written and verbal communication skills
- Interpersonal/human relations skills
Working conditions
Environmental Conditions: Medical Office environment
Physical Conditions:
- Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
- Must be able to sit and/or stand for prolonged periods of time
- Must be able to bend, stoop and stretch
- Must be able to lift and move boxes and other items weighing up to 30 pounds.
- Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.