Job Overview
Company: Alliance Healthcare Solutions
Employee Type: Full-Time
Industry: Healthcare - Health Services
Manages Others: No
Job Type: Health Care
Job Location: Southwestern Suburb
Required Education: Not Specified
Required Experience: At least 2 year(s)
Required Travel: Not Specified
Relocation Covered: Not Specified
Contact: Lauren Simmons



Medical Appeals Specialist

Job Description

Alliance Healthcare Solutions has partnered with a Healthcare Revenue Cycle Solutions organization in a Cleveland southwest suburb. We are currently seeking an Appeals Specialist for Medical Insurance organization.


Job Description:

The Appeals Specialist is responsible to respond to assigned second and third level denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. To submit external review requests and required documentation to the state within the filing time limits. Act as a patient advocate by identifying the path needed to obtain the maximum reimbursement under the insurance plan and work with the patient to get the denial overturned.


Key Responsibilities:

  • Review assigned denials and EOB’s for appeal filing information. Gather any missing information
  • Review case history, payer history, and state requirements to determine appeal strategy
  • Obtain patient and / or physician consent when required by the insurance plan or state
  • Obtain medical records when required by the insurance plan or state
  • Gather and fill out all special appeal or review forms
  • Create appeal letters, attach the materials referenced in the letter, and mail them
  • Coordinate phone hearings with the insurance company, patient and physician
  • Comply with all 2nd, 3rd, and External Level Appeal process, system, and documentation SOP’s
  • Meet appeal filing deadlines by completing assigned work list tasks in a timely matter and / or reporting to management when assistance is needed to complete the tasks
  • Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager
  • Participate in team and appeal meetings by sharing the details of cases worked
  • Act as a backup on answering incoming telephone calls as needed
  • May undertake special projects assigned by the Team Leader or Reimbursement Manager

 






Job Requirements

Requirements:

  • High School diploma or GED
  • Minimum of four years health insurance billing experience
  • Knowledge of managed care industry including payer structures, administrative rules, and government payers
  • Past leadership experience
  • Proficient in all aspects of reimbursement
  • Detail oriented
  • Possess excellent written and verbal communication skills
  • Able to establish priorities, work independently, and proceed with objectives without supervision.
  • Proficient in using Microsoft Excel and Word


Company Overview

Our mission is to match your talent to the best jobs in the marketplace that provide you with the greatest opportunities for success.

Alliance Healthcare Solutions is the premier staffing service for Allied, Nursing, Clinical and Clerical Healthcare professionals. It's also one of the fastest growing companies in Northeast Ohio! If you are an experienced healthcare professional, or just starting your career, you need a resource that understands the unique skills of your profession.

Alliance Healthcare Solutions employs experienced, specialized recruiters that align themselves with our candidates and customers to establish long-term qualified partnerships that generate positive results.

Alliance Healthcare Solutions offers competitive compensation, health benefits, holiday and retention pay, and referral bonuses.

** Alliance's services are always free to candidates **


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