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Why You'll Love This Job

  • Research denials and determine if there is a legitimate case for overturning the denial. 
  • Verify that all pertinent documentation which substantiates the appeal arguments are organized and complete, and that the appeal letter is logically argued. Ensure the documentation utilized is recorded according to internal quality standards. Use the best, most compelling evidence available to support the argument presented in the appeal. Recognize and obtain missing yet necessary documentation to complete the appeals package. Review and verify appeal exhibits/evidence for accuracy. 
  • Proof-read and edit the appeal letter, as necessary. Ensure appeal letter contains no spelling, grammatical, or syntax errors before being submitted to the client for review. 
  • Ensure that the appeal is written and submitted according to internal documentation control protocols and timely filing. 
  • Communicate and collaborate with internal and external team members to promptly, accurately, and professionally address any questions or concerns that arise because of the appeal review or writing and submission process and escalate customer concerns to Inform manager of payor trends or problems or changes in payor requirements. 
  • Follow up on all Corrected claims and appeals submitted. 
  • Make clear, detailed notations in EMR system on all accounts worked.  
  • Calculate expected claim reimbursement. 
  • Have a working knowledge of payor policy guidelines and payor contracts.  
  • Have a clear understanding of fee schedules. 
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