Remote Medical Appeals Specialist

Overview

The Remote Medical Appeals Specialist is responsible for reviewing patient accounts denied for insurance reimbursement or paid incorrectly and following through with the appeal process to secure payment. This role requires effective communication, thorough research of claims, and collaboration with financial service units to resolve discrepancies and improve reimbursement rates.

In Short

• Reviews denied claims and incorrect payments, initiating the appeals process.
• Communicates with patient financial service units for accurate account processing.
• Collaborates with appeals representatives for workload management.
• Researches and resolves claim discrepancies using revenue codes and insurance guidelines.
• Analyzes explanation of benefits (EOBs) to identify payment discrepancies.
• Responds to inquiries from departments and insurance carriers.
• Works with Managed Care Department to improve claim management.
• Maintains logs and reports of outstanding appeals.
• Assists case workers with pre-certification and authorization issues.
• Complies with all policies and standards.

Requirements

• H.S. Diploma or GED required.
• Associate Degree in Healthcare Administration or related field preferred.
• 1-3 years of experience in claims processing or revenue cycle management required.

Benefits

• Competitive salary.
• Work from home flexibility.
• Opportunity for professional growth.
• Comprehensive benefits package.
• Supportive team environment.