Appeals Specialist in Orange Park at Parallon

Date Posted: 10/3/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Orange Park
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:
    10/3/2018

Job Description

Job Summary – The Appeals Specialist is responsible for performing end to end tasks for technical appeals.

Supervisor –Appeals Manager

Duties (included but not limited to):
  • Triage incoming inventory for the Appeals team, validating appeal criteria is met
  • Compose technical denial arguments for reconsideration, including both written and telephonically
  • Identify contract protection that can be leveraged to overturn denials.
  • Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
  • Identify problem accounts/processes/trends and escalate as appropriate
  • Utilize effective documentation standards that support a strong historical record of actions taken on the account.
  • Ability to perform basic math to ensure accurate statement of accounts receivable
  • Meet the productivity and quality standards of the organization
  • Timely completion and comprehension of all educational requirements
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Other duties as assigned

Job Requirements

KNOWLEDGE, SKILLS & ABILITIES
• Communication - communicates clearly and concisely, verbally and in writing. This includes utilizing proper punctuation, correct spelling and the ability to transcribe accurately.
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations
• Interpersonal skills - able to work effectively with other employees, patients and external parties
• PC skills - demonstrates proficiency in Microsoft Office applications and others as required
• Policies & Procedures - demonstrates knowledge and understanding of organizational policies, procedures and systems
• Technical skills - Professional presentation skills needed to represent facilities in legal issues.
• Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately
• Clinical skills – ability to read and interpret medical records a plus
 
EDUCATION
High school diploma or GED required

EXPERIENCE
Minimum one year of experience in related area required

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