Medicare Appeals Specialist
Do you like challenging payers? Enjoy that feeling of satisfaction when your appeal is overturned? Then, this position may is right for you.
The ideal candidate will be well versed in the Medicare managed care appeals and grievance process. Must have strong knowledge of Medicare payer guidelines and applicable state laws.
RESPONSIBILITIES:
- Developing well-supported appeal arguments, where an appeal is warranted.
- Filing complaints and grievances through the CMS and Medicaid systems to resolve unfair payment practices and trends.
- Filing complaints with Medicare and Medicaid agencies when claims are denied in error.
- Perform follow up on any outstanding claims, manage correspondence and requests and research denials and zero payments
MINIMUM REQUIREMENTS/QUALIFICATIONS:
- 3 to 5+ years of recent experience writing insurance appeals and pursuing Medicare for collection on behalf of hospitals (facility charges).
- Understanding of medical terminology, bill review, general coding, and appeals resolution.
- Ability to read, analyze, and interpret hospital medical bills, records, statutes, contracts, and other relevant documents.
- Knowledge of medical necessity, time filing, and contract denials.
- High comfort level with Excel
- 50+ wpm
- Excellent oral and written communication skills.
- Ability to pass a thorough background check and drug screen.