Wichita, Kansas
Medical Claims Appeals Representative Job Opening in Wichita, Kansas - An Appeals Representative will review, research and resolve all types of medical claim appeals from members and providers within stringent timeframes. Medical billing experience or health insurance industry experience preferred.
Essential Functions:
Log each appeal as it is received
Prepare acknowledgement and response letters to members and providers
Identify, reach, and resolve claim disputes
Prepare and submit appeals for Claims Review Committee
Review and respond to legal requests
Develop and maintain an excellent working knowledge of policies in order to determine eligible benefits and understand how claims were processed or why they were denied
Assist providers and members with questions regarding their claims, appeals or policies both in writing and verbally
Provide backup coverage for the call center
Abide by HIPAA regulations and other privacy policies at all times
Maintain an exemplary attendance and tardiness record following established company guidelines
Demonstrate ability to work well with other departments and all Medova staff members
Complete other tasks, as assigned
Competencies:
Technical Capacity
Problem Solving
Attention to Detail
Initiative
Required Education and Experience:
High School Diploma or equivalent
Knowledge of medical terminology and diagnosis and procedure codes
Preferred Education and Experience:
Additional course work in the medical field
2 year health insurance industry knowledge
Computer Skills:
Microsoft Outlook
Microsoft Word
Microsoft Excel
Data Entry
Ten Key
Position Type and Expected Hours of Work:
Full-time
Monday-Thursday 8am-5pm; Friday 8am-4pm (general)
At least a 30 minute lunch required daily
Work Environment:
Professional office environment
Standard office equipment such as computer, phone, postage machine, and copier/scanner/fax
Tobacco free
Job Type: Full-time
Job Location:
Wichita, KS
Required education:
High school or equivalent
Required experience:
medical billing or coding: 1 year
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