We are seeking an Appeal Specialist to support the functions of our Revenue Cycle Appeal team by assisting in the review of denied and underpaid claims for the formal appeal and dispute process with payors. This role plays a critical part in ensuring accurate classification of appeals, thorough research of accounts, and preparation of necessary documents. The Appeal Specialist will engage with patients to obtain required information and maintain meticulous documentation in our billing software.
Essential Functions/Duties
Review Explanation of Benefits, denial letters, and payor correspondence to determine the type of appeal required.
Gather, prepare, and meticulously review documentation and forms needed for appeals according to payor guidelines.
Communicate with patients via phone and/or mail to gather necessary information for the appeal process.
Document details, requirements, and deadlines of each appeal in our billing software.
Utilize reports to manage daily workflow and ensure timely processing of accounts.
Follow up promptly and regularly with payors regarding the status of appeals.
Identify payor issues within the appeal process and collaborate with leadership on workflow improvements.
Perform additional duties as assigned.
Education
High School diploma or equivalent.
Skills
Strong knowledge of healthcare billing procedures, reimbursement, third-party payer regulations, documentation, and standards.
Familiarity with Blue Cross Blue Shield payors is advantageous.
Ability to interpret Explanation of Benefits (EOB) from payors.
Exceptional problem-solving skills, attention to detail, and ability to make timely decisions.
Excellent internal and external customer service skills.
Proactive responsiveness and dedication to meeting internal and external deadlines with minimal supervision.
Qualifications
Required Experience:
Fluent in English.
Minimum of one (1) year of advanced medical billing experience.
Professional written and verbal communication skills.
Proficient with computers and related technology.
Ability to work independently and as part of a team.
Preferred Experience (Not Required)
Minimum of one (1) year working in a call center environment.
Above-average knowledge of insurance billing guidelines and policies.
Experience with Commercial Insurance appeal and reconsideration processes.
Employment Type: Full-Time
Seniority level
Entry level
Employment type
Full-time
Job function
Health Care Provider
Industries
Human Resources Services
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