Appeals Specialist in Houston, TX at Parallon

Date Posted: 8/1/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Location:
    Houston, TX
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:
    8/1/2018

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 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