appeals representative

$35,942 - $38,022/Yr

Randstad - Louisville, TN

Full-time - Entry Level

Louisville, TN

Administrative and Support Services

About the position

The Appeals Representative plays a crucial role in the healthcare team by managing and processing appeals related to medical billing. This position requires a detail-oriented individual with experience in medical billing and knowledge of physician billing policies. The representative will work closely with insurance carriers to resolve claim denials and ensure accurate billing practices.

Responsibilities

• Reviews ETM task list assignment, comments, and rebills/appeals claim as necessary
• Reviews denials to determine appropriate action based on carrier requirements
• Posts appropriate rejection codes into system where applicable
• Obtains status by establishing carrier contact if the submitted appeal has yielded no response
• Identifies and forwards documentation to appeal disputed claims
• Assembles and forwards appropriate documentation to the senior representative for provider and carrier related issues
• Reviews carrier provider manuals for billing updates as needed
• Reports any consistent errors found during review that affect claims from being processed correctly
• Participates in department meetings with Accounts Receivable Team
• Identifies trends in claims filed outside carrier timely filing deadlines and offers suggestions to prevent future occurrences
• Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
• Performs any and all duties as directed by Senior Representative, Supervisor, and Accounts Receivable Manager

Requirements

• 1 year of experience in medical billing (preferred)
• Knowledge of Physician Billing
• Computer literate
• Excellent organizational skills
• Ability to work independently

Benefits

• Health insurance
• Incentive and recognition program
• 401K contribution