Medicare Specialist - Appeals in Nashville, TN at Parallon

Date Posted: 7/13/2018

Job Snapshot

Job Description

DUTIES INCLUDE BUT ARE NOT LIMITED TO:
  • Maintains current knowledge of all office operations, job specific requirements and related regulations.
  • Reviews all claims for completeness, reasonableness of charges, and appropriateness of billing codes, and payer information.
  • Pursues timely collection of each claim using thorough follow-up efforts appropriate to each payer.
  • Reviews, makes corrections to, and insures the legibility of outgoing secondary bills, and other correspondence before sending.
  • Handles all incoming phone calls and inquiries in an appropriate manner.
  • Properly processes and responds to incoming correspondence.
  • Contacts and effectively communicates with all parties involved in the resolution of accounts placed.
  • Completes work request timely and in accordance with instruction.
  • Performs all of the task necessary to maintain current and accurate account information in each of the appropriate systems (i.e. entering notes, claims on hold).
  • Forwards and logs all documentation related to processes and duties which are transferred to other employees.
  • Brings problems and troubling accounts, as well as related questions, to his/her immediate supervisor’s attention daily.
  • Exercised good judgment and makes sound decisions in the absence of detailed instructions or in an emergency situation.
  • Treats client request with a high priority. Quickly informs supervisor and any other personnel needed to help carry out the request timely, accurately, and according to instruction.
  • Strives to improve current operations by identifying inefficiencies and recurring problems, and by making suggestions to the immediate supervisor.
  • Adapts and conforms to company and client requirements not specified in this job description/performance review.
  • Promotes the Medicare Service Center and helps to identify the necessary resources to meet the needs of its customers.
  • Practice and adhere to the “Code of Conduct” philosophy and “Mission and Value Statement”
  • Other duties as assigned

Job Requirements

KNOWLEDGE, SKILLS & ABILITIES
  • Knowledge of Medicare regulations.
  • Knowledge of UB-92 billing.
  • Knowledge of 1500 billing.
  • Knowledge of ICD-9/10 and CPT-4 coding.
  • Analytical and organizational skills.
  • Ability to identify, set, and follow priorities.
  • Knowledge of hospital business office operations.
  • Strong PC and data entry skills.
  • Ability to communicate effectively with employees, clients, and others.
  • Character to maintain strict confidentiality.

 
EDUCATION
  • High school graduate or equivalent.