Appeals Representative (REMOTE)

Job Description

TeamHealth is named among the 150 Great Places to Work in Healthcare by Becker’s Hospital Review and has ranked three years running as The World’s Most Admired Companies by FORTUNE Magazine as well as one of America’s 100 Must Trustworthy Companies by Forbes Magazine in past years.

TeamHealth, an established healthcare organizations is physician-led and patient-focused. We continue to grow across the U.

S. from our Clinicians to our Corporate Employees and we want you to join us.

• Career Growth Opportunities
• Benefit Eligibility (Medical / Dental / Vision / Life) the first of the month following 30 days of employment
• 401K program (Discretionary matching funds available)
• GENEROUS Personal time off
• Eight Paid Holidays per year
• Quarterly incentive plans
• The Akron, OH billing center has multiple openings for Appeals Representatives. These are remote, work-from-home positions*

JOB DESCRIPTION OVERVIEW :

The Denials & Appeals Representative will review, organize, and monitor incoming payment denials, taking appropriate corrective action.

The Analyst responds to carrier issues as needed and processes all appeals including Medicare, Medicaid, Blue Shield, and Commercial carriers.

ESSENTIAL DUTIES AND RESPONSIBILITIES :

• Monitor and review all payment denials as assigned in Enterprise Task Manager and process these claims in the time frame assigned within the system
• Utilize the telephone and various carrier websites as research tools to expedite resolution for issues
• Assembles and forwards documentation to appeal disputed claims through Waystar
• Assist with research and development of appropriate denial procedures
• Contacts carriers to inquire on claims that have been denied and appealed
• Assembles and forwards appropriate documentation to the Senior Analyst for provider related issues
• Review carrier manuals and websites and informs management of any new procedures implemented by the carrier that are impacting our claims
• Reports any consistent errors found during claims review that may affect claims from being processed correctly
• Consistently meet established completion times for projects and assignments
• Consistently meet and maintain the QA (95% or better) and designated production standards per sub-team
19 days ago