Appeals Specialist 1 - EverStaff
Cleveland, OH 44199
About the Job
Everstaff is seeking Appeals Specialists for a reputable company in the MIddleburg Hts area!
Responsibilities:
- Review assigned denials and Explanation of Benefits (EOBs) to identify necessary information for appeal filing and gather any missing details.
- Analyze case history, payer history, and state requirements to develop an effective appeal strategy.
- Obtain patient and/or physician consent, as well as medical records, when required by the insurance plan or state.
- Complete all required special appeal or review forms.
- Draft appeal letters, attach relevant supporting documents, and ensure they are sent to the appropriate recipients.
- Coordinate phone hearings with the insurance company, patient, and physician.
- Adhere to SOPs for first, second, third, and external level appeals, ensuring compliance with the process, system, and documentation requirements.
- Meet appeal filing deadlines by completing assigned tasks on time and reporting to management when additional support is needed.
- Report changes in insurance company or state requirements, along with denial trend updates, to the Team Leader and Reimbursement Manager.
- Participate in team and appeal meetings, sharing updates on cases worked.
- Serve as backup for answering incoming calls when needed.
- Take on special projects as assigned by the Team Leader or Reimbursement Manager.
- Consistently meet predetermined productivity goals based on appeal level.
- Maintain a quality standard of 90% or higher.
- Perform other duties as assigned.
Qualifications:
- High School diploma or GED.
- Minimum of four years of health insurance billing experience.
- Knowledge of the managed care industry, including payer structures, administrative rules, and government payers.
- Proficiency in all aspects of reimbursement.
- Ability to maintain confidentiality.
- Strong attention to detail.
- Excellent written and verbal communication skills.
- Ability to prioritize tasks, work independently, and achieve objectives with minimal supervision.
- Proficiency in Microsoft Excel and Word
Pay: $19-20/hr
Company offers:
- Casual Environment
- PTO & Paid Holidays
- Great benefits
- Career Development
Qualified candidates, please submit your resume for immediate consideration!
All qualified applicants will receive consideration for employment without regard to race, color, religion, ethnicity, national origin, sex, gender identity, sexual orientation, disability status, protected veteran status or any other protected status under the law.
EverStaff is an equal opportunity employer (M/F/D/V/SO/GI)
Source : EverStaff