Appeals Specialist

Job description

Qualifications: - Review assigned denials and EOB’s for appeal filing information. Gather any missing information. - Review case history, payer history, and state requirements to determine appeal strategy. - Obtain patient and/or physician consent and medical records when required by the insurance plan or state. - Gather and fill out all special appeal or review forms. - Create appeal letters, attach the materials referenced in the letter, and mail them. - Coordinate phone hearings with the insurance company, patient, and physician. - Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP’s. - Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks. - Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager. - Participate in team and appeal meetings by sharing the details of cases worked. - Act as a backup on answering incoming telephone calls as needed. - May undertake special projects assigned by the Team Leader or Reimbursement Manager. - Ability to meet predetermined...