McLeod Health APPEALS SPECIALIST - MANAGED CARE DEPARTMENT in Florence, South Carolina
APPEALS SPECIALIST - MANAGED CARE DEPARTMENT
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.
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.
- Minimum of a High school Diploma/GED from an accredited school plus 2 years of experience in patient financial services required.
Full-time, 80 hrs bi-weekly
Florence, South Carolina, United States
Position Type Details
2210 Enterprise Drive Florence, SC 29501