East Memphis Surgery Center - Central Business...
Lead Appeals Specialist
East Memphis Surgery Center - Central Business..., Memphis, Tennessee, us, 37544
Lead Appeals Specialist
JOB SUMMARY:
Responsible for revealing and resolving denied claims, including contracting insurance companies, providers, and patients, as well as drafting or generating appeal letters when necessary. Must be an effective communicator who can express himself/herself daily in a professional manner both verbally and in writing, and be a proactive professional who can identify payer trends and solve or escalate them in a timely manner.
DUTIES AND RESPONSIBILITIES:
Provides assistance and education to appeals team members regarding processes for working denials received.
Primary point of contact for all appeals processing related questions.
Ability to conduct research of claims that are unpaid or underpaid due to payer denial to identify cause and perform appropriate follow-up actions to get claims 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 recover 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.
EDUCATION/EXPERIENCE:
HS Diploma or Equivalent.
Results-oriented and thrives in a fast-paced, high-energy environment.
Able to develop and maintain good communication and establish positive working relationships with payers, peers, and leadership.
Develops and maintains, in conjunction with manager, processes for successfully completing and submitting reconsiderations/appeals.
Has the ability to organize work and manage change.
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JOB SUMMARY:
Responsible for revealing and resolving denied claims, including contracting insurance companies, providers, and patients, as well as drafting or generating appeal letters when necessary. Must be an effective communicator who can express himself/herself daily in a professional manner both verbally and in writing, and be a proactive professional who can identify payer trends and solve or escalate them in a timely manner.
DUTIES AND RESPONSIBILITIES:
Provides assistance and education to appeals team members regarding processes for working denials received.
Primary point of contact for all appeals processing related questions.
Ability to conduct research of claims that are unpaid or underpaid due to payer denial to identify cause and perform appropriate follow-up actions to get claims 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 recover 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.
EDUCATION/EXPERIENCE:
HS Diploma or Equivalent.
Results-oriented and thrives in a fast-paced, high-energy environment.
Able to develop and maintain good communication and establish positive working relationships with payers, peers, and leadership.
Develops and maintains, in conjunction with manager, processes for successfully completing and submitting reconsiderations/appeals.
Has the ability to organize work and manage change.
#J-18808-Ljbffr