Appeals Specialist I - Denials
- Submit electronic and hard copy billing and conduct follow up with third party carriers for insurance claims.
- Investigate and coordinate insurance benefits for insurance claims across multiple service lines.
- Obtain claim status via the telephone, internet, and/or fax.
- Review and understand eligibility of benefits.
- Resolve accounts as quickly and accurately as possible, obtaining maximum reimbursement, and perform investigative and follow up activities in a fast-paced environment.
- Conduct research, contact patients, and the local affiliates to include VA, Hospitals, and insurance carriers.
- Handle incoming and outgoing mail, scanning, and indexing documents and handling any other tasks that are assigned.
- Research and verify insurance billing adjustment identification to ensure proper account resolution and act when necessary.
- Identify contractual and administrative adjustments.
- Work independently or as a member of a team to accomplish goals.
- Demonstrate excellent customer service, communication skills, creativity, patience, and flexibility.
- Follow established organization guidelines to perform job functions while staying abreast to changes in policies.
- Correspond with hospital contacts professionally using appropriate language while following the specific facility and department protocol.
- Uphold confidentiality regarding protected health information and adhere to HIPPA regulation.
- Interact with all levels of staff.
- Cross train in multiple areas and perform all other duties as assigned by management.
- Active listening
- Ability to multi-task
- Exceptional phone etiquette
- Strong written and oral communication skills
- Effective documentation skills
- Strong organizational skills
- Service orientation
- Reading comprehension
- Critical thinking
- Social perceptiveness
- Time management and reliable attendance
- Fast learner
- High School Diploma or equivalent
- Bachelor's degree preferred, or equivalent combination of education, training, and experience
- 2 or more years of experience of hospital billing, insurance follow-up, denials, or appeals preferred
- Remote work experience preferred
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