appeals representative

About the position

The Appeals Representative position at Randstad US involves working within a stable healthcare team to manage and resolve medical billing appeals. The role requires a candidate with experience in medical billing and knowledge of physician billing policies, focusing on reviewing claims, denials, and ensuring proper documentation is submitted for appeals.

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 policies and procedures
• Excellent organizational skills
• Computer literate
• Ability to work independently

Benefits

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