Torrington, Connecticut
Appeals Coordinator/Reimbursement Specialist/Coder Job Opening in Torrington, Connecticut - Appeals Specialist/Coder This is an exciting opportunity to join a rapidly growing company!!! PRIA Healthcare Management is a patient access and reimbursement solutions company specializing in patient based appeals of denied care. We are currently looking for an Appeals Coordinator ready to join our team of skilled and dedicated individuals supporting the mission of patient access to care and customer service. We prefer previous experience working in a reimbursement capacity within a healthcare organization. Previous Medical Billers and Certified Coding Specialists are a plus Must be proficient in Microsoft office-Word and Excel and must demonstrate excellent oral and written skills. We also prefer previous experience working with appeals and prior authorization process. Must be proficient in Microsoft office-Word and Excel and must demonstrate excellent oral and written skills. Our ideal candidate will:
Provide review at all levels of appeal
Research clinical records, appropriate insurance regulations, and history of claim to determine next steps
Utilizes appropriate resources to gather supporting documentation (i.e.: state protocols, physician/hospital medical records, state or federal statutes, patient/physician letters, etc.)
Works with management to assist in escalation strategy
Understands and tracks adverse denial trends and presents them to management
Interacts closely with payer appeals and utilization departments.
Researches payer statutes, regulations, and regional requirements
Comply with company HIPAA laws and other policies and procedures.
Qualifications:
Experience working with insurance claims, appeals, prior auth, and utilization review is preferred but not a must.
College degree preferred but will substitute applicable work experience
Experience with medicare, Medicaid, Tricare, workers compensation, and private commercial insurance
Must demonstrate the ability to draft a professional and effective appeal letter
Expertise in CRM software, internet based is a plus.
Must have solid knowledge of patient account systems and ability to troubleshoot and suggest improvements
Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees both with the clients and with physician practices
Knowledge of general office procedures and use of office equipment
Demonstrate expertise in MS Office suite software
This position will be based out of our Torrington, CT location
Job Type: Full-time
Job Location:
Torrington, CT 06790
Required education:
Associate
Required experience:
Medical Billing: 1 year
Required license or certification:
CPC
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