Appeals Specialist - Patient Accounts

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 ensure 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.

MINIMUM EDUCATION

High School Graduate or GED Equivalent required; relevant experience in lieu of High School Diploma/GED education will be considered. Associate’s or Bachelor’s Degree in a Business related field highly preferred. Foreign Medical Graduates welcome.

MINIMUM WORK EXPERIENCE

Three to five years of job related experience.

REQUIRED LICENSES/CERTIFICATIONS

None.

REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES

Must be computer literate; possess good verbal and written communication skills, and excellent analytical skills.