Medix
Appeals Specialist
Medix, Richmond, Texas, United States, 77406
Medix's Richmond-based client is looking for an experience Appeals Specialist (Collector)! Apply if qualified and interested!
Positions:
Appeals SpecialistExpected Shift/Hours:
Monday through Friday; Standard 8am-5pm CSTExpected Duration:
5 months; True Contract to hire roleStart Date:
12/2/2024
Overview
The Appeals Specialist will manage the organization's third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines. This position will develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims. The Appeals Specialist will lead the organization's denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials.
The Appeals Specialist will work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports. The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
Duties
Validate denial reasons and ensure accuracy and reflects the denial reasonsCoordinates for clinical consultations or account referrals when necessaryGenerate an appeal based on the dispute reason and contract terms specific to payerFollow specific payer guidelines for appeals submissionEscalate exhausted appeal efforts for resolutionReview denial reasons on EOBs to determine denialsEnter denied claims into databaseWork payer projects as directedIdentify denial & variance trendsSelling Points
Nationally Recognized for "A" in The Leapfrog Hospital Safety GradeOpportunity for career advancement over time3-5 Must Have Skills/Qualifications
1+ years of appeals experience required3-5 years of appeals and follow up experience preferredUnderstand/ability to read EOBsComfortable working in a metrics based environmentAbility to work independentlyDress Code
Business Casual
How do you apply?
Click "Apply" OR or email your resume!
Medix is acting as an Employment Business in relation to this vacancy.
Positions:
Appeals SpecialistExpected Shift/Hours:
Monday through Friday; Standard 8am-5pm CSTExpected Duration:
5 months; True Contract to hire roleStart Date:
12/2/2024
Overview
The Appeals Specialist will manage the organization's third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines. This position will develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims. The Appeals Specialist will lead the organization's denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials.
The Appeals Specialist will work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports. The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
Duties
Validate denial reasons and ensure accuracy and reflects the denial reasonsCoordinates for clinical consultations or account referrals when necessaryGenerate an appeal based on the dispute reason and contract terms specific to payerFollow specific payer guidelines for appeals submissionEscalate exhausted appeal efforts for resolutionReview denial reasons on EOBs to determine denialsEnter denied claims into databaseWork payer projects as directedIdentify denial & variance trendsSelling Points
Nationally Recognized for "A" in The Leapfrog Hospital Safety GradeOpportunity for career advancement over time3-5 Must Have Skills/Qualifications
1+ years of appeals experience required3-5 years of appeals and follow up experience preferredUnderstand/ability to read EOBsComfortable working in a metrics based environmentAbility to work independentlyDress Code
Business Casual
How do you apply?
Click "Apply" OR or email your resume!
Medix is acting as an Employment Business in relation to this vacancy.