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Appeals Specialist in Orange Park at Parallon

Date Posted: 4/4/2019

Job Snapshot

  • Employee Type:
  • Location:
    Orange Park
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:

Job Description

Job Summary – The Appeals Specialist is responsible for performing end to end tasks for
technical appeals.
Supervisor –Appeals Manager
Supervises – not applicable

Duties (included but not limited to):
*Triage incoming inventory for the Appeals team, validating appeal criteria is
*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
*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

• Communication - communicates clearly and concisely, verbally and in writing. This
includes utilizing proper punctuation, correct spelling and the ability to transcribe
• 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
• 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
• 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

High school diploma or GED required
Minimum one year of experience in related area required