Job Summary
The Appeals Specialist II, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report trending. This position provides SSC and ancillary departments all payor updates regarding billing and coding updates/changes, completes timely and consistently reports project status SSC leadership and maintains confidentiality of data and information. This position provides feedback to facilities regarding denials that are resulting in retractions.
Essential Functions
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Responsible for review and resolution of pre pay insurance denials, correlating with the follow-up teams.
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Works closely with Denial Coordinator, Facility Denial Liaison, and Managed Care Coordinator for education and payer accountability.
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Consults with managers and staff on developmental needs for new processes and makes recommendation to change.
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Maintains knowledge of practice management systems, basic coding and billing knowledge, customer service techniques, basic insurance/carrier knowledge, and front office operation policies.
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Gathers and makes available appropriate educational resources (e.g. books, video tapes/audio Works with associates, departments and facilities to understand denial/appeal management processes.
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Performs other duties as assigned.
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Complies with all policies and standards.
Qualifications
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H.S. Diploma or GED required
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Bachelor's Degree in Nursing required
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1-3 years experience in healthcare revenue cycle or business office required
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1-3 years experience in healthcare insurance medical billing preferred
Knowledge, Skills and Abilities
- To perform this job successfully, an individual should have knowledge of Word Processing software, spreadsheet software and database software.
Licenses and Certifications
- RN-BC - Certified General Nursing Practice current license to practice in state required
Equal Employment Opportunity
This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.
