Appeals Specialist

ID: 10405

City: Athens Area

State: Georgia

Posted: May 13, 2019

Appeals Specialist

 

Location: Athens, GA Area

Compensation: $17.00/hour

 

DUTIES AND RESPONSIBILITIES:

  • Prepare and submit clean claims to insurance companies using electronic and paper systems
  • Prepare and submit invoices to patients, physicians, hospitals, laboratory’s, and other providers of services as identified by client
  • Process responses from health insurance companies
  • Perform claim adjustments
  • Successfully resolve edited, rejected, and denied claims
  • Prepare and file appeals as necessary
  • Interpret EOBs (explanation of benefits) and perform actions based on EOB
  • Prepare, review, and send patient and client statements
  • Answer questions from patients, clerical staff and insurance companies
  • Identify and resolve patient and client billing complaints
  • Obtain and update patient demographic information
  • Collect and provide medical records upon request
  • Track and report status of delinquent accounts
  • Review accounts for possible assignment and make recommendations to Billing & Support Manager
  • Conduct pre-collection actions including contacting patients and clients by phone and correcting and resubmitting claims to third party payers
  • Participate in educational activities and attend staff meetings
  • Maintain strictest confidentiality; adheres to all HIPAA guidelines/regulations
  • Conduct self in accordance with employee manual
  • Other duties as specified

Requirements

 

Skills

  • Strong familiarity with medical billing/collection practices
  • Strong understanding of basic medical coding and 3rd-party operating procedures
  • Knowledge of CPT and ICD-9/ICD-10 coding systems is highly desirable
  • Ability to develop effective working relationships with patients, clients, employees, and the public
  • Update voicemail and email responses when out of office
  • Reliable ability to effectively operate business phones, including:
    • Maintaining a pleasant, helpful presence on calls
    • Ability to use a multi-line phone system
    • Timely response to voicemail messages
  • Windows and MS Office proficiency, including Outlook
  • Proper use of time entry systems
  • Effective written and verbal communication skills
  • Basic business math skills
  • Strong organization skills
  • Attention to detail

 

Experience

  • Experience in customer service situations, particularly the proven ability to effectively handle billing-related customer issues

 

Education

  • High School diploma necessary
  • 2-year degree in Accounting, Information Management or Healthcare-related field highly preferred
  • Coding or Medical Billing Certification highly preferred
hp123

* Mandatory fields