APPEALS SPECIALIST - TMC BONHAM (FULL TIME)

TMC Bonham Hospital - Bonham, TX

Full-time

Bonham, TX

11-50 employees

Hospitals

About the position

The Appeals Specialist at TMC Bonham Hospital is responsible for managing the appeals process for insurance denials, ensuring compliance with Managed Care contracts and government fee schedules. This role involves analyzing data related to denials and preparing reports to identify trends, ultimately aiming to improve the quality of care and patient safety in a critical access hospital setting.

Responsibilities

• Appeal all insurance denials and prepare relevant reports regarding trends in denials.
• Ensure accurate and timely appeals to third party payers in compliance with Managed Care contracts and government fee schedules.
• Obtain, manipulate, and analyze data from various resources including hospital/physician billing systems and external contract/claims management.
• Collaborate with departmental personnel to gather and exchange data with key medical and third party professionals.

Requirements

• Certification in medical coding and billing preferred.
• 2-3 years of experience in customer service, healthcare appeals processing, or insurance industry.
• Strong knowledge of clinical documentation, Medicare rules, and regulations.
• Excellent interpersonal communication and problem-solving skills.
• Experience with Microsoft Office and internet websites.