Monday - Friday 9:00am - 3:00pm (flexible)
Set your sights on a role making a real difference in the healthcare system. We’re looking for a self-motivated Appeals Specialist to join our team. We have a relentless focus on driving results for our customers and enabling them to invest more into patient care; in turn, this allows us to continue to grow our company and your career.
The Appeals Specialist will be responsible for investigating and examining denial accounts, will apply appropriate methods and techniques as established internally to resolve applicable issues, follows through with unresolved accounts, provides feedback to the appropriate staff on where the process went wrong, and keeps staff educated on all current trends in the appeals arena. Utilizes computer systems/programs, processes, policies and procedures as they apply to the positions entailed duties and be able to trouble-shoot issues as they arise within the assigned specialization group. In addition, this position is required to learn how to conduct research analysis and work closely with third party payers to answer relevant questions and obtain appropriate information in pursuit of resolving unpaid claims. Appeals Specialist incumbents must be assessed as being resourceful and having extensive knowledge in area applicable to the assigned specialization group. Acts under direct supervision while learning to make complex decisions within the scope of this position.
- Investigates and examines source of denials utilizing knowledge of charge master, AS400, ICD-9 coding, CPT coding and EDI billing.
- Reads and interprets expected reimbursement information from EOB's and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB.
- Works closely with third party payers to resolve unpaid claims in proving medical necessity of the patient's admission.
- Works with HIM and PAS across the enterprise in resolving adverse benefit determinations.
- Work closely with Appeals staff (Letter writers, Case Managers and Hearing specialists) in obtaining all pertinent information in a timely manner.
- Performs duties as given by supervisor to fill in where needed: covering phones, sorting mail, scanning and filing or any other office function within the CAU.
- Maintains and follows all HIPAA and confidentiality requirements.
- Demonstrated extensive knowledge in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third Party contracts, minimum of two years experience in a specified area.
- Demonstrated excellent analytical, fact-finding, problems solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients, and insurance plan administrators.
- Demonstrated ability to work successfully in a team setting.
R1 is changing healthcare by infusing operational discipline and proprietary technology in hospital financial processes. We are an industry leader; we are the only independent organization with a comprehensive service and technology offering for hospital revenue cycle management, and we have achieved leading outcomes for our customers.
- A strong financial performing, growing organization that will keep you on your toes with new ideas, changes and opportunities to learn and grow in abundance.
- A culture of excellence, driving customer success so they can focus on improving patient care and on giving back to the community.
- A Total Rewards package which may include such things as: competitive compensation package, the ability to choose from a comprehensive benefit program mostly funded by R1 that includes medical, dental, vision, flexible spending accounts, commuter benefits, life and disability insurance, along with work life balance programs including paid time off for personal time, illness and volunteering, and we offer a retirement savings plan and continuing training and development and so much more!
Sound like you? Let’s talk!
R1 is a leading provider of revenue cycle management services and Physician Advisory Services to healthcare providers. We are the largest independent end-to-end revenue cycle provider and have the longest operating history in the revenue cycle industry. R1’s objective is to be the one trusted partner to manage revenue so providers and patients can focus on what matters most. Our distinctive operating model and values includes people, processes, and sophisticated integrated technology/analytics that help customers realize sustainable improvements in their operating margins and improve the satisfaction of their patients, physicians, and staff. We are dedicated to transforming the commercial infrastructure and patient experience in healthcare.