Revenue Cycle Medical Billing Commercial Appeal Specialist

Revenue Cycle Medical Billing Appeal Specialist - Commercial

Location: Remote or On-Site (West Plains, MO)

Hourly Pay: $20

This position is bonus eligible

Work Schedule: Training M-F 8am-5pm CST,

Flex Hours (after training) M-F 7am-7pm CST

JOB SUMMARY

The Commercial Appeal Specialist supports the functions of the Revenue Cycle Appeal team by assisting in the review of denied and underpaid claims for the formal appeal and dispute process with the payor. Responsibilities include, but are not limited to; classification of appeals, research of accounts, preparing documents, obtaining appeal status, and review of appeal determinations.

ESSENTIAL FUNCTIONS/DUTIES

• Review Explanation of Benefits, denial letters, and payor correspondence to classify type of appeal required.
• Gather, prepare, and review documentation and various forms needed to submit appeals correctly per payor guidelines.
• Engage patients via phone and/or mail to obtain requested information pertaining to the appeal process.
• Document the details, requirements, and deadlines of each individual appeal in billing software.
• Use reports to manage daily workflow and ensure accounts are processed within required timeframes.
• Timely and regular follow-up with payors regarding status of appeals - Makes routine phone calls and contact to payor/insurance for status and/or discussion of appeal determination or outcome.
• Ability to identify payor issues within the appeal process and discuss potential improvements and workflow solutions with leadership.
• Additional duties as assigned.

QUALIFICATIONS

Required Experience:

• Must be fluent in English
• Minimum of one (1) year of medical billing experience
• Professional written and verbal communication skills
• Knowledge of navigating insurance payor portals
• Ability to verify insurance claim status and complete medical records
• Knowledge and experience of computers and related technology at an intermediate level
• Ability to work independently with little or no direction and as a member of a team

Preferred Experience:

• Minimum of one (1) year working in a call center environment
• Above average knowledge of insurance billing guidelines and policies
• Experience with Commercial Insurance processes and policies
• Experience with BCBS Insurance

Preferred Education:

• High school diploma
• GED
• Or significant, relevant work experience