Appeal Resolution Specialist jobs in West Virginia

Review unpaid and underpaid claims to ensure that claims are paid accurately and timely according to company policies, payer contracts, and governmental regulations. Perform follow up on unpaid or underpaid claims to ensure that claims are completely resolved accurately and timely and efforts are thoroughly documented.

Responsibilities

Review assigned work items daily to resolve “at risk, past due, and technical denial” claim issues Work with coding to resolve coding related denials Work with Utilization Review to resolve authorization related denials and appeals Use various payer web portals and DDE systems to obtain claim information that will help in resolution Contact payers by phone to resolve claim issues Contact Physician offices to obtain necessary information needed to resolve claims Manually and accurately resolve claims in Suspense (Medicare only) Ensure that medical records and itemized statement are submitted and received when requested by payers (work with contracted agencies as applicable) Follow proper workflow assigned by management Ensure accurate rebilling of claims to avoid denials Communicate billing errors that can be prevented to Department Manager, Supervisor, or Team Lead Communicate identified system related issue to Department Manager, Supervisor, or Team Lead Accurately, Professionally, and thoroughly document necessary information necessary to resolve outstanding balances in encounter timeline Ensure that result driven follow up is be accomplished and documented. Other duties as assigned Skills: Healthcare billing and collection knowledge Ability to interpret a payer explanation of benefit (EOB) Ability to identify and resolve claim issues Excellent communication and customers service skills Computer and keyboarding skills Knowledge of Microsoft software applications (Excel and Word) a plus Cerner knowledge a plus

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education

• High School Diploma or GED (Required) Experience: 1-2 years collections, customer service, or other comparable experience. Medical Terminology background and 5-7 years related experience preferred.

Credentials

Work Schedule: Days

Status: Full Time Regular 1.0

Location: General Hospital

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Lisa J. Craft lisa.craft@vandaliahealth.org