Remote Medical Denials / Medical Appeals Specialist

Job Description

This is a remote position.

The orientation hours are Monday-Friday from 8:00am - 4:30pm CST (CST time) for approximately one week.

The training hours are Monday-Friday from 8:00am-4:30pm AZ MST (Arizona Mountain Standard Time)for approximately 3 months. The hours may be able to flex back to 6:30 or 7am AZ start if the candidate lives in a CST or EST time zone, depending on individual preferences and performance circumstances.

The working hours are Monday-Friday from 8:00am-4:30pm AZ MST. (This schedule will begin after training is completed.) The hours may be able to be modified to start any time between 6:00am to 8:30am AZ MST, depending on individual preferences and performance circumstances.

Summary: The Appeals Specialist 1, under the direction of the Director of Denial Support Services, logs and reviews per documentation guidelines for report trending. This position provides SSC and ancillary departments all payor updates regarding billing and coding updates/changes, completes timely and consistently reports project status SSC leadership and maintains confidentiality of data and information.

Essential Duties and Responsibilities: (List in order of importance or percentage of time spent on the particular responsibility. High to Low)

• Responsible for review and resolution of pre pay insurance denials, correlating with the follow-up teams. (20%)
• Works closely with Denial Coordinator, Facility Denial Liaison, and Managed Care Coordinator for education and payer accountability. (20%)
• Consults with managers and staff on developmental needs for new processes and makes recommendation to change. (20%)
• Maintains knowledge of practice management systems, basic coding and billing knowledge, customer service techniques, basic insurance/carrier knowledge, and front office operation policies. (20%)
• Gathers and makes available appropriate educational resources (e.g. books, video tapes/audio Works with associates and departments to understand denial/appeal management processes. (20%)

Qualifications:

Required Education: High School Diploma or Equivalent

Required Experience: 1+ years experience in healthcare revenue cycle setting

Preferred Experience: 1+ years experience in healthcare revenue cycle setting including chart review, denial processing

Required License/Registration/Certification: None