Work in various appeal worklists, focusing on contracted or sensitive insurance companies as needed. Communicate denial and appeal trends to client engagement and payer relations teams. Serve as a subject matter expert (SME) in insurance appeals, working with management to update clients. Obtain patient consent and medical records for appeals when required by insurance plans. Gather updated appeal or review forms to add to the form library. Create and submit appeal letters per client standard operating procedures (SOP) via portal, fax, or mail. Comply with all appeal process documentation and SOPs. Participate in team meetings to share case details and best practices. Train new or less experienced appeals team members. Undertake special projects assigned by management or clients. Review denials and Explanation of Benefits (EOBs) for appeal filing information, identifying missing details. Communicate incorrect or missing appeal information to management. Complete special appeal or review forms. Initiate and complete payer projects, maintaining tracking spreadsheets. Collaborate with global teams to demonstrate processes. Work toward obtaining Lean Six Sigma (LSS) Yellow Belt or higher. Meet or exceed productivity and quality key performance indicators (KPIs). Perform other assigned duties.
High School diploma or GED required. Minimum of four years of health insurance billing experience or equivalent degree. At least one year of Quadax production experience. Proficient with PAS and HARP systems. Excellent written and verbal communication skills. Knowledge of managed care industry, including payer structures, administrative rules, and government payers. Proficient in all aspects of reimbursement. Ability to work independently, prioritize tasks, and maintain confidentiality. High attention to detail. Proficient computer skills, including Microsoft Excel and Word.
Location
Ohio, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago