Licensed Appeal Writer - Remote

Job Purpose

The Licensed Appeal Writer supports the Company by reviewing insurance claims denied for payment on behalf of our client hospitals. Working closely with nurses and other team members, the Licensed Appeal Writer creates appeal letters in support

Duties & Responsibilities

Review denied insurance claims

Review patients’ medical files

Develop strategies to reverse claim denials

Create written appeals

Manage and organize appeal workflow based on internal, client-based, and insurance-driven deadlines

Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Understand and comply with Information Security and HIPAA policies and procedures at all times

Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

4-year degree or work equivalency required

Must hold an active license as a Physician's Assistant (PA), Registered Nurse (RN), Nurse Practitioner (NP), Licensed Practical Nurse (LPN), Physical Therapist (PT), Occupational Therapist (OT), or an equivalent professional license

Strong analytical, communication, and documentation skills are essential

Must be able to prioritize workload based on strict deadlines

Must be tech-savvy with ability to quickly learn new software

Must possess a high level of reading comprehension and ability to analyze medical information and terminology

Proficiency in Microsoft Office Suite

Strong interpersonal skills, ability to communicate well at all levels of the organization

Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

High level of integrity and dependability with a strong sense of urgency and results oriented

Excellent written and verbal communication skills required

Gracious and welcoming personality for customer service interaction

Working Conditions

Physical Demands : While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear.

Mental Demands : The employee must be able to follow directions, collaborate with others, and handle stress.

Work Environment : The noise level in the work environment is usually minimal.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.