Description Job purpose • The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment. Duties and responsibilities • Reviews and appeal unpaid and denied claims • Attaches appropriate documents to appeal letters • Researches and evaluates insurance payments and correspondence for accuracy • Logs appeals and grievances, and tracks progress of claims • Keeps up-to-date reports and notates any trends pertaining to insurance denials • Calls insurance companies to inquire about claims, refund requests and payments • Manages Accounts Receivable reports for the Billing Department • Utilizes EMR system to submit and correct claims • Posts patient and insurance payments • Sends paper claims to insurance carriers • Answers patient billing questions • Coordinates medical and billing records payments with patients and/or third-party payers • Handles collections on unpaid accounts • Identifies and resolves patient billing complaints • Answers phone calls to the Billing Department in a timely and professional manner • Processes credit card payments over the phone and in person • Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements • Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments • Operates standard office equipment (e.g. copier, personal computer, fax, etc.). • Has regular and predictable attendance • Adheres to Advanced Pain Care’s Policies and procedures • Performs other duties as assigned Requirements Qualifications Education: Requires a high school diploma or GED Experience: Three or more years related work experience with medical billing/ claims Previous use of Athena required Knowledge, Skills and Abilities: • Clear and precise communication • Ability to pay close attention to detail • Effectively manages day by organizing and prioritizing • Possesses excellent phone and customer service skills and abilities • Protects patient information and maintains confidentiality • Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding • Familiarity with analyzing electronic remittance advice and electronic fund transfers • Experience interpreting zero pays and insurance denials • Competence in answering patient questions and concerns about billing statements • Organizational skills and ability to identify, analyze and solve problems • Works well independently as well as with a team • Strong written and verbal communication skills • Interpersonal/human relations skills Working conditions Environmental Conditions: Medical Office environment Physical Conditions: • Must be able to work as scheduled – typically from 8:00 – 5:00 M-F • Must be able to sit and/or stand for prolonged periods of time • Must be able to bend, stoop and stretch • Must be able to lift and move boxes and other items weighing up to 30 pounds. • Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.