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Appeals Specialist
- Posted: November 06, 2024
- Salary:US$23 - US$28 per hour
- Location:Richmond
- Job type: Contract
- Discipline:Revenue Cycle
- Reference:234957_1730945606
- Work Location:
Job description
Medix's Richmond-based client is looking for an experience Appeals Specialist (Collector)! Apply if qualified and interested!
Positions: Appeals Specialist
Expected Shift/Hours: Monday through Friday; Standard 8am-5pm CST
Expected Duration: 5 months; True Contract to hire role
Start Date: 12/2/2024
Overview
The Appeals Specialist will manage the organization's third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines. This position will develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims. The Appeals Specialist will lead the organization's denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials.
The Appeals Specialist will work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports. The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
Duties
- Validate denial reasons and ensure accuracy and reflects the denial reasons
- Coordinates for clinical consultations or account referrals when necessary
- Generate an appeal based on the dispute reason and contract terms specific to payer
- Follow specific payer guidelines for appeals submission
- Escalate exhausted appeal efforts for resolution
- Review denial reasons on EOBs to determine denials
- Enter denied claims into database
- Work payer projects as directed
- Identify denial & variance trends
Selling Points
Nationally Recognized for "A" in The Leapfrog Hospital Safety Grade
Opportunity for career advancement over time
3-5 Must Have Skills/Qualifications
- 1+ years of appeals experience required
- 3-5 years of appeals and follow up experience preferred
- Understand/ability to read EOBs
- Comfortable working in a metrics based environment
- Ability to work independently
Dress Code
- Business Casual
How do you apply? Click "Apply" OR or email your resume!
Medix is acting as an Employment Business in relation to this vacancy.