Appeals Specialist in Orange Park, FL at Parallon

Date Posted: 7/23/2018

Job Snapshot

  • Employee Type:
    Full-Time
  • Job Type:
  • Experience:
    At least 1 year(s)
  • Date Posted:
    7/23/2018

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 working with medical claim appeals / denials.



Parallon