Billing Appeals Specialist - REMOTE

Job Description

Description

Hospital Appeals for a Full Time, Remote, 1.00 FTE, Day position.  Hourly compensation starts at $17.61, more depending on experience.

This position will be performed fully remote. If telecommuting, PeaceHealth will provide the caregiver with necessary computer equipment. It is the responsibility of the caregiver to provide Internet access.

Must reside in Washington, Oregon, Texas or Alaska.

Responsible for the resolution of appeals relating to technical issues identified during the billing of claims and the follow-up on the clinical appeals performed by the clinical auditor. Ensures acceptable reimbursement and appropriate days in Accounts Receivable by initiating, processing, and resolving all appeals.

DETAILS OF THE POSITION:

• Drafts appeals to insurance companies for reimbursement of monies owed and initiates formal appeals.
• Processes and maintains correspondence received from patients and insurance companies as they pertain to logging, tracking, and processing technical denials.
• Conducts pertinent research in order to evaluate, respond to, and close appeals.
• Identifies more complex appeals issues and reports to clinical auditor and Appeals Team Manager.
• Communicates appeal issues with payors/providers to aid in resolution of denials.
• Produces reports of received denials, noting disposition and recoveries
• Ensures compliance with organizational and regulatory guidelines. Ensures compliancy is met and processes claims in accordance with contracts and policies. Adjudicates claims as appropriate.

WHAT YOU BRING:

• Minimum of two years’ experience in a billing or insurance account follow-up capacity is required; Formal training or college coursework from an accredited medical coding school, specific to medical billing in lieu of experience may be considered
• Medical terminology experience required
• Knowledge of insurance processes and billing guidelines regulations required
• Coding knowledge preferred
• Epic experience, specifically Resolute Billing Module experience preferred
• Ability to read and understand insurance EOB’s and to understand payor contracts.
• Proven ability to communicate effectively with payors and provider offices, either by written or spoken means.
• Proficient use of computers including Microsoft Office 2010 applications
• Ability to work with minimal supervision, independently, as well as in a collaborative team setting
  
• Strong organizational skills with the ability to prioritize and meet deadlines
• Knowledge of Commercial and/or Government Payors
• Ability to lift objects weighing 30 lbs. or less.

For a full description of the position, or for questions, please email [email protected]

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For full consideration of your skills and abilities, please attach a current resume with your application.  EEO Affirmative Action Employer/Vets/Disabled in accordance with applicable local, state or federal laws.