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McLeod Health APPEALS SPECIALIST - MANAGED CARE DEPARTMENT in Florence, South Carolina

APPEALS SPECIALIST - MANAGED CARE DEPARTMENT

Tracking Code

20212378

Job Description

  • Ability to manipulate data in spreadsheets in order to report trends and statuses to Manager.

  • Investigate, determine, pursue, and overturn with accuracy and timeliness denied accounts by insurance payers. Thoroughness and reliability are essential because of the nature of the work and for credibility with the payers.

  • Negotiate and insist accountability with third party payers on accounts through accurate and timely follow-up.

  • Document precisely and timely in contract management software.

  • Utilize available resources (online websites, contract management software, payer contacts) to aid in the expedient recovery of denied funds.

  • Maintain a high level of professionalism while aggressively overturning denied claims by third party payers.

  • Must be flexible, able to work independently and able to achieve deadlines and deliverables with minimal supervision.

  • Perform other duties as assigned by Manager.

  • Read and understand payer explanation of benefits or remittance advice to appropriately resolve denials.

  • Excellent written and oral communication skills.

Qualifications /Training:

  • Working knowledge of billing/coding terminology (e.e ICD-10, CPT, Revenue Code)

  • Working knowledge of Patient Financial Services

  • Procedural knowledge of account receivable management

  • Understanding of basic revenue cycle

  • Excellent interpersonal, written and organizational skill required

  • Experience with problem solving techniques

  • Minimum of one year healthcare appeals experience is preferred. Minimum of two years’ experience with Excel and Word.

Licenses/Certifications/Registrations/Education:

  • Minimum of a High school Diploma/GED from an accredited school plus 2 years of experience in patient financial services required.

Work Schedule:

  • Full-time, 80 hrs bi-weekly

    Job Location

    Florence, South Carolina, United States

    Position Type

    Full-Time/Regular

Position Type Details

Full-Time

Physical Address

2210 Enterprise Drive Florence, SC 29501

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