Round Rock, Texas
Appeals Specialist Job Opening in Round Rock, Texas - The Appeals Specialist within our organization is responsible for managing medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. Where warranted, the Appeals Specialist will write sound, compelling factual arguments to the insurance company. The Appeals Specialist will also handle audit-related correspondence and other administrative duties as required. The Appeals Specialist will work directly with the insurance company, healthcare provider, and patient to get a claim processed and paid.
Essential Functions:
Review and appeal unpaid and denied claims
Answer patients? billing questions
Handle collections on unpaid accounts
Manage the facility?s Accounts Receivable reports
Answer questions from patients, clerical staff and insurance companies
Identify and resolve patient billing complaints
Evaluate patient?s financial status and establish budget payment plans
Follow and report the status of delinquent accounts
Review accounts for possible assignment and make recommendations to the Billing Manager
Perform various collection actions including contacting patients by phone, correcting and resubmitting claims to third party payers
Maintain strictest confidentiality
Adhere to all HIPAA
Utilize computerized accounting software programs (CMS, Excel, Word) to perform duties and responsibilities
Process credit card payments
Other Job Requirements:
Logs, tracks, processes appeals and grievances.
Conducts pertinent research in order to evaluate, respond to, and close appeals in accordance with all established regulatory guidelines
Processes changes in information system to support accurate and efficient billing process
Familiar with standard concepts, practices, and procedures within the medical field
Works under general supervision
A certain degree of creativity and latitude is required
Typically reports to a supervisor or manager
Demonstrates regular and predictable attendance
Adheres to all company policies and procedures.
Knowledge, Skills, and Abilities:
Attention to detail and accuracy
Good verbal and written communication skills
Organizational skills
Problem analysis and problem solving skills
Team member
Stress tolerance
Sense of urgency
Customer service skills
Knowledge of CPT, ICD-9, and ICD-10 coding and medical terminology
Minimum Qualifications:
Education: Requires a high school diploma or GED. Bachelor?s degree in related field is preferred.
Experience Required : At least 3 years? experience in healthcare billing and/or appeals experience.
Benefits: Full Time Position with Great Benefit package (Life, Medical, Dental, Vision, Retirement, PTO, Gym Membership, and other supplemental options)
Job Type: Full-time
Required education:
High school or equivalent
Required experience:
Medical Billing: 2 years
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