Appeals Specialist

Austin Gastroenterology is seeking an experienced Appeals Specialist.

Duties of this position include, but are not limited to, the following:

Position purpose

Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues, and generating appeals for denied or underpaid claims.

Responsibilities/Duties/Functions/Tasks:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Research and resolve claim denials and appeals in accordance to insurance policy, rules and regulations.
• Responsible for managing multiple cases simultaneously within specific time frames
• Follow up on all returned claims, correspondence, denial, account reconciliation and rebills to achieve maximum reimbursement in a timely manner
• Work with all insurance companies to resolve denials to get claims paid
• Work within established guidelines when necessary to process appeal for denied requests
• Responsible for timely resolution of all claims including corrected claims, appeals and communicating with agency personnel on incorrect payer data
• Follow specific payer guidelines for appeals submission
• Escalate exhausted appeal efforts for resolution
• Perform other duties as assigned.

Education: High school diploma or equivalent

Experience: Minimum of two (2) years of medical billing and collection experience required; prior medical billing denials and appeals processing experience preferred.

Qualifications

• Thorough understanding of medical terminology; CPT and ICD10 coding rules.
• Excellent written and verbal communication skills
• Excellent customer service skills are required
• Experience reviewing EOB and UB-04 forms
• Ability to multi-task and work in fast-paced environment.
• Detail-oriented
• Be able to read and understand medical benefits.
• Bilingual is a plus.

Additional Qualifications: N/A

Performance Requirements:

• Ability to dispute claim payments
• Excellent communication skills, both written and verbal.
• Proficient technical (computer) skills.
• Ability to multi-task and prioritize.
• Self-motivated with initiative.
• Strong sense of ethics.

Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.

NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.

No phone calls or agencies, please.

EEO/AA-M/F/disabled/protected veteran