Medical Appeals & Denials Specialist

Job Description

• They are handling the full cycle process of figuring out WHY a CLAIM was DENIED and from there RESEARCHING and figuring out WHAT needs to be done to get it into the appeals process

• They are dealing 99% of the time with insurance companies and Medicare/Medicaid

• HEAVY phones

• They do all the work until the actually appeals letter is sent out. When that letter is sent out another department takes over.

• They will work off of 6 proprietary systems, each unique to the client (hospital system) they are working with. Since they have an influx of new hospitals as clients this is what they will work on the majority of their days.

• Critical thinking skills are very important

Qualifications

• Must have Claims, Appeals and Denials experience of 2 years coming from hospital and/or physician background

• Must have billing knowledge, as well as Commercial Insurance, Medicare, Medicaid, ICD 10, CPT Codes and understand the various billing forms, such as CMS 1500 and HCFA 1500 (types of billing forms used for hospital/physicain billing)

• Must have worked the FULL CLAIM, not just entered a piece of the pie into the system (things they should know or have worked on: Why was the claim denied? Was it due to the DOB (date of birth) being entered in incorrectly? Or was medical necessity not sufficient?) These are examples of things they should be use to researching and then coming to a resolution.

• Must be very organized

• Must be able to work at a very fast pace

• Must not be scatter brained

• Must be able to work off many different web applications and dual screens

• Must be very proficient with Excel spreadsheets as that is what they are given their work off of (sorting, filtering, etc.)

Additional Information

Hours for this Position:

M- F 730-4p or 8a-430p

Advantages of this Opportunity: 

• Competitive salary $14.00– 16.00 per hr  

• Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO 

• Growth potential 

• Fun and positive work environment

Company Description

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!