Appeals Specialist

Surgery Partners Tampa , FL 33602

Posted 3 months ago

This Tampa, FL- based position is responsible for reviewing and resolving denied claims including contracting insurance companies, providers and patients as well drafting or generating appeal letters when necessary. Must be an effective communicator who can express himself/herself on a daily basis in a professional manner both verbally and in writing as well as be a proactive professional who can identify payer trends and solve or escalate them in a timely manner.

  • Ability to conduct research of claims that are unpaid or under paid due to payer denial to identify cause, and perform appropriate follow up actions to get claim resolved timely

  • Contact various sources including insurance professionals, patients, and other parties to verify relevant data

  • Responsible for obtaining claim status and gathering supporting documentation to submit appeals

  • Assist in defending Surgery Partners' rights to recovery against insurance companies

  • Interact with provider office staff members to obtain appropriate documentation for claims and appeals submission

  • Identifies any payer trends and resolves or escalates as appropriate

  • Successfully reduces days in A/R and meets productivity goals

The ideal candidate is:

  • Results oriented & thrives in a fast-paced, high-energy environment

  • At least 1 year of medical clinical appeal experience preferred

  • Able to develop and maintain good communication with and establish positive working relationships with payers, peers and leadership

  • Knowledge of medical terminology and ability to analyze claims to determine reason for denial and appeal appropriately

  • Has the ability to organize work and manage change

  • CPC certification preferred

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Appeals Specialist

Surgery Partners