Medical Billing - Revenue Cycle – Appeal Determination – Medicare
On-Site or Remote
Starting Pay $18.00
The Appeal Determination – Medicare position is responsible for reviewing incorrectly processed and/or denied claims to determine next appropriate actions to resolve the claim.
Essential Functions/Duties
· Effectively process remittance advice notices from Medicare claims (primary, secondary, tertiary) to determine next actions.
· Obtain and document necessary reprocessing and/or appeal related data to resolve the incorrectly processed/denied claim in a timely and efficient manner.
· Assure process and resources are allocated to provide required payor documentation assembly and filing in a timely manner.
· Analyze work processes to maximize efficiency.
· Work to achieve team and departmental goals.
· Work effectively as a member of a team.
· Communicate clearly and concisely, both orally and in writing.
Qualifications:
Required Experience
· Must be fluent in English
· Minimum three (3) years experience in healthcare/revenue cycle billing environment
· Above average knowledge of Medicare and/or Medicare Replacement billing guidelines
· Ability to read and decipher an explanation of benefits and/or remittance advice notice
· Minimum of one (1) year working in a call center environment
· Ability to work independently or as an active member of a team
· Must possess empathic and professional written and verbal communication skills
· Knowledge and experience of computers and related technology, at an intermediate level
Preferred Experience
· A minimum of one (1) year working in a customer service
Education
· High school diploma or equivalent
Skills:
· Knowledge of health care billing procedures, reimbursement, third party payer regulations, documentation, and standards
· Knowledge of health care billing compliance regulations
· Knowledge and understanding of payor Explanation of Benefits (EOB)/ Remittance Advice (RA) notice
· Requires strong problem-solving skills, attention to detail, and ability to make timely decisions
· Intermediate computer skills and familiarity with Microsoft Office, especially Excel
· Ability to adapt to change
· Above average internal and external customer service skills
· Responsiveness and a strong commitment to meeting internal and external deadlines with limited supervision
· Above quantitative, analytical, and problem-solving skill
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