Cross America Financial

APPEALS SPECIALIST 

Do you like challenging payers?  That feeling of satisfaction when your appeal is overturned?   Then, this position may be right for you!   

CAF is in search of an experienced Appeals Specialist who is well versed in challenging insurance denials, utilizing payer guidelines and applicable state laws.  The ideal candidate must have the ability to multitask, meet goals and work well individually and with others on special projects and individual workloads.     

RESPONSIBILITIES: 

• Developing well-supported appeal arguments, where an appeal is warranted.
• Work with and contact insurance companies to resubmit denied/underpaid claims that are inaccurately processed and continually upheld. 

• Notate system of record thoroughly and accurately. 
• Filing complaints and grievances through the DMHC, DOI, DOL, CMS and Medicaid systems to resolve unfair payment practices and trends.   
• Filing complaints to the jurisdiction of HMO, PPO, ERISA, 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 payers 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, UCR and contract denials. 
• High comfort level with Excel 

• A focused, organized, and detail-oriented approach to work. 
• 50+ wpm 
• Knowledge of Milliman/InterQual guidelines 
• Excellent oral and written communication skills. 
• Ability to pass a thorough background check and drug screen.  

• Ability to perform critical work under deadlines.  
• Ability to work in a changing environment and handle multiple tasks 

PREFERRED (NOT REQUIRED): 

• Compiling appeals and collecting for hospital/facility component with general knowledge of insurance follow-up 
• Experience with billing and collection systems such as CUBS, Meditech, Cerner etc. 

ABOUT CAF:  

CAF is a fast-growing revenue cycle agency exclusively serving hospitals, and conveniently located at the intersection of the 405 and 110 freeways. We utilize amazing customer service to help hospitals bill, service and collect more of the money they are due, so they may continue to provide critical healthcare services to their patients. Our team members strive to be better every single day, to do quality work, and to make a lasting impact on their lives and the lives of others.  

COMPENSATION & BENEFITS  

Full-time position.  Pay commensurate with experience. Paid training.  Generous paid vacation, holidays, 401k, Aflac supplemental insurance (at employee expense), and monthly bonus opportunities for those who qualify. No company paid medical benefits at this time. Plenty of growth opportunities for friendly, focused, results-driven people.