Medical Appeals Specialist

Position Summary: The Medical Appeals Specialist is responsible for identifying and coordinating the reconsideration and appeal process for all improperly denied claims. The Medical Appeals Specialist is primarily responsible for ensuring the completion, accuracy and compliance in the appeal process. The ideal candidate will have experience in physician practice billing, coding and documentation compliance with a working knowledge of Medicare, Medicaid, commercial insurance, and managed care.

Basic Qualifications:

Education: Associates or Bachelor's degree in business or related field is preferred. Appropriate experience can be substituted for education.

Certification: CPC, RHIA, RHIT, or CCS is required.

Experience: At least 3 years' experience in healthcare revenue cycle, billing and coding required.

Specialty certification or experience in an ophthalmology practice preferred.

Essential Job Responsibilities:
• Ensures accurate and timely billing is occurring in accordance with specific payer requirements.
• Directly manages the reconsideration and appeal functions.
• Monitors open reconsiderations and appeals and supplies any requested additional requirements.
• Establishes effective communication between billers and providers to address any deficiencies.
• Ensures all guidelines are followed and all correspondence is completed accurately and in a timely manner.
• Provides direction for physician coding staff regarding performance improvement initiatives based on documentation and coding review findings.
• Provides coding/documentation education to providers.
• Ensures excellent customer service and professionalism when interacting with fellow team members, payers, patients and providers to ensure all are treated with kindness and respect.
• Performs other related job duties as assigned, which could include special projects.