Job Description
Job Description:
The Appeals Resolution Specialist is responsible for conducting the research needed to evaluate, process, and create appeals, and respond to payer disputes and reconsiderations to ensure a timely decision. This position works closely with the Contract Management Analysts to present data on appeal trends and final resolutions. In collaboration with Payment Integrity Manager, this position will aid in the research and trending of payer payment issues and provide root cause analysis as to the issues.Education Qualifications:
Key Responsibilities:
- Initiate level 1 appeals with payers
- Review response from payers on level 1 appeals and initiate level 2 appeals if necessary
- Submit appeals and reconsiderations on claim rejections, underpayments and denials
- Initiates insurance follow up on unresolved claims
- Identify, track, and report payer appeal/denial trends to management
- Refers appeal cases to the designated department for obtaining support for appeals
Educational Requirements:
- Associate’s degree in accounting, business or related medical field
Required Qualifications:
- 1-3 years experience in revenue cycle operations
Preferred Qualifications:
- Previous experience in medical appeals submissions
- Knowledge of EOB’s, EFT payments, claims submission, denials, and ANSI codes
- Understand Medicare and Medicaid rates
- High attention to detail, be able to multitask, and prioritize tasks
- Must be proficient in MS office and Excel
- The ability to work independently and as part of a team
- Excellent written and verbal communication skills
Job Location: Business Service Center
Shift Rotation: Day Rotation (United States of America)
Shift Start/End: 8:00/5:00
Hours Per Pay Period: 80
Compensation Range: $39603 - $59010 / year
Union: DC USWA Main & Neighborhoods (DCUMN)
FTE: 1
Weekends:
Call Obligations:
Sign On Bonus:
Job Details
Job Title
Appeals Resolution Associate
Position Type
Full Time
Requisition ID
R063629