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 position at Randstad General Staffing involves reviewing and processing medical billing appeals within a stable healthcare team. The role requires excellent organizational skills and computer literacy, with a focus on ensuring accurate claims processing and compliance with carrier requirements.

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

• High school diploma or GED
• 1 year of experience in medical billing
• Knowledge of physician billing policies/procedures
• Excellent organizational skills
• Computer literacy

Benefits

• Health insurance
• 401(k)
• 401(k) matching