The Medical Billing Appeals Specialist is responsible for corresponding with health insurance payers to resolve outstanding balances related to denials and underpayments in accordance with established standards, guidelines, and requirements.The Medical Appeals Specialist proactively reviews and researches all accounts assigned and comples all necessary activity to resolve claims.
• Medical coder with a minimum four years of coding and/or medical appeals experience
• Medical Coding Certificate; RHIT or CPC by AHIMA or AAPC license; meet state licensure requirements preferred
• Maintain coding certification and attends in-service training as required, as applicable
• Strong analytical skills and ability to apply coding expertise, regulatory knowledge and payer requirements when making decisions regarding claim denials and whether an appeal is warranted.
• Excellent writing and interpersonal communication skills to prepare and communicate convincing appeal arguments as deemed appropriate.
• Accurate and precise attention to detail and excellent critical thinking skills
• Knowledge of various managed care reimbursement methodologies
• Advanced organizational and time management skills to ensure all appeal deadlines are met.
• Ability to identify, initiate and implement business practices, policies and processes
• Demonstrated ability to establish and maintain effective working relationships with internal and external parties