The Appeals Specialist is responsible for managing and coordinating the workflow for all Audit Activity. This individual manages denial/appeal correspondence, assures accounts are assigned to the appropriate department for review, and performs timely follow-up. This individual also is responsible for accurately entering data into C360, Cerner, ClaimIQ, Artiva, and the Appeal Tracker. Quality work is imperative for the department to run efficiently.
Essential Duties and Responsibilities
(List in order of importance or percentage of time spent on the particular
responsibility – High to Low
1 . Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals . and communicates daily with Sr. Director/Manager on trends identified
2 . Responds to queries within 72hrs, appropriately documents in Cerner/ClaimIQ/Artiva, and tracks all activity in the Appeal Tracker.
3 . Manages PDFU to assure timely follow-up of accounts to effectively move .
through the revenue cycle
4 . Completes claim appeals and assists with other projects, as needed. .
5 . Submits requests for medical records, ub’s, and itemized bills as needed. .
6 . Responsible for being aware of the current department policies and procedures .
7 . Meet or exceed quality and quantity benchmark targets as established by .
management (productivity, AR days, Cash Collections, Bad Debt, Past Due Follow Up)
8 . Ability to perform all other duties as assigned or requested
9 . Ensure confidentiality of all patient accounts by following HIPAA guidelines.
Job Type: Full-time
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
Schedule:
- Day shift
- Monday to Friday
Work setting:
Application Question(s):
- Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals and communicates daily with Sr. Director/Manager on trends identified. Responds to queries within 72hrs, appropriately documents in Cerner/ClaimIQ/Artiva, and tracks all activity in the Appeal Tracker. Manages PDFU to assure timely follow-up of accounts to effectively move through the revenue cycle
Work Location: Remote