Appeals Processing Representative

Full-time - Entry Level

New Hyde Park, NY

Professional, Scientific, and Technical Services

About the position

The Appeals Processing Representative plays a crucial role in the Operations team at the Lake Success Office, focusing on revenue recovery and clinical denials management. This position involves evaluating, prioritizing, and entering incoming correspondence into the company's database to ensure timely resolution of outstanding appeals. The role requires strong organizational skills and the ability to work in a fast-paced environment, supporting hospital revenue cycle efforts.

Responsibilities

• Manages the workflow for incoming correspondence from client hospitals, insurance companies, and review agencies.
• Evaluates all incoming mailings and documents to determine appropriate actions, status, routing notation, and follow-up.
• Reviews and analyzes appeal determination letters to appropriately classify denial type to ensure timely documentation and processing.
• Tracks and assigns cases using internal coding statuses within PARR management system.
• Scans, labels, and files all incoming communications into applicable shared drives and folders.
• Creates, sends, and confirms receipt of outgoing correspondence as needed including the uploading and faxing of appeal documentation to payer portals and external agencies.
• Handles additional office tasks, such as filing, emailing, faxing, and uploading paperwork.
• Performs necessary follow-up with responsible departments and delegated entities to ensure accuracy and efficiency in a timely manner.
• Documents final resolutions along with all required data to facilitate accurate reporting, tracking, and productivity metrics.
• Reports workflow improvements to management regarding issue resolution, root cause analysis, and best practices.
• Identifies barriers and roadblocks in work processes, recommends solutions, and implements management approved actions.
• Develops an understanding of the different processes/functions in the Operations units and is cross-trained in order to assist others when necessary.
• Maintains customer confidence and protects operations by keeping information confidential in compliance with HIPAA and PHI standards.

Requirements

• Experience with Microsoft Office including MS Excel and Word
• Strong typing, computer, and data entry skills
• Effective time management skills, and be results driven
• Ability to work under pressure and multitask in a fast-paced environment
• Excellent attention to detail with strong organizational skills
• Prioritization of workload to effectively problem solve and attain resolution
• High school diploma required, Bachelor's preferred
• 1-3 years of related experience, preferably in Healthcare
• Must adhere to all Covid-19 protocols

Nice-to-haves

• Bachelor's degree preferred
• Experience in Healthcare

Benefits

• Paid Health Insurance
• Employer Sponsored Pension & Profit Sharing Plans
• Paid Time Off; Sick, Vacation
• Year-End Performance-Based Bonuses
• Growth and Advancement Opportunities