Community Health Systems Appeals Specialist Sr in Sarasota, Florida

Description:

Summary: The Appeal Specialist Sr is responsible formanaging and coordinating the workflow for the Appeal Team. This individual manages denial/appealcorrespondence, assures accounts are assigned to the appropriate nurse forappeal review, and performs timely follow-up for appeal determinations. This individual also is responsible foraccurately entering data into the appeal log. Quality work is imperative for the department to run efficiently.

EssentialDuties and Responsibilities:

  • Manages workflow for all incoming denial/appeal letters & auditcorrespondence via centralized email and isynergy folders.

  • Accurately vets accounts; meets or exceeds quality & quantitybenchmark targets as established (productivity/PDFU)

  • Directs ClaimIQ/Artiva requests to appropriate parties for appeal review& validation.

  • Completes ClaimIQ/Artiva requests within 72hours and documentsappropriately

  • Manages PDFU to assure timely follow-up of accounts to effectively movethrough the revenue cycle.

  • Accurately enters data into logs, DAR/Artiva, or other programs.

  • Submits requests for medical records, ub s, and itemized bills asneeded.

  • Coordinates external audit activity and appeal vendor activity

  • Provide clerical assistance to the Denial Management Team by assistingwith correspondence, appeal letters, maintaining software libraries and mailingand tracking their receipt.

  • Post 986 adjustments for commercial accounts, as requested by Sr.Director

  • Ability to perform all other duties as assigned or requested.

Qualifications

Qualifications:

  • Communication - communicate clearly and concisely, verbally and in writing; utilize appropriate method/tool to communicate with other departments as necessary

  • Interpersonal skills - able to work effectively with other employees and external parties

  • Policies & Procedures - demonstrate knowledge and understanding of organizational policies, procedures and systems; ensure confidentiality of all patient accounts by following HIPAA guidelines

  • Performance - maintain performance standards that ensure the department is operating at peak proficiency and that established goals are consistently being met

  • Time management and organization - perform work under tight guidelines, must be detail oriented and well organized. Ability to prioritize and control workload.

  • Demonstrated critical thinking, creativity, problem solving and decision-making skills

  • Basic skills - able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly and transcribe accurately

  • Working knowledge of the revenue cycle

  • Working knowledge of medical terminology and/or insurance claim filing experience

Reasoning Ability:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.

Computer Skills:

To perform this job successfully, an individual should have knowledge of Word Processing software, Spreadsheet software and E-mail software

Certificates and Licenses: None

Supervisory Responsibilities: None

Education/Experience:

Associate's degree (A. A.). In addition, Bachelor's degree (B.S. or B.A.) from four-year college or University and/or two to three years related experience.

Job: Business Office Support

Organization: Shared Services Center - Sarasota

Location: FL-Sarasota

Requisition ID: 1818679