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Carrot Peelers, Sales, Personality and Your Job Search
Public Interest
Legal Staff
Litigation - Whistleblower - CFTC
Other
$14.27
Min 2 yrs required
Appeals Specialist I Duties: Investigates and examines source of denials utilizing knowledge of charge master, AS400, ICD-9 coding, CPT coding and EDI billing. Reads and interprets expected reimbursement information from EOB’s and learns legal parameters pertaining to all State and Federal Laws that pertain to the plan benefits pertaining to the EOB. Works with third party payers to resolve unpaid claims in proving medical necessity of the patient’s admission.. Works with HIM and PAS across the enterprise in resolving adverse benefit determinations. Works closely with Appeals staff (Letter writers, Case Managers and Hearing specialists) in obtaining all pertinent information in a timely manner. Performs duties as given by supervisor to fill in where needed: covering phones, sorting mail, scanning and filing or any other office function within the CAU. Maintains and follows all HIPAA and confidentiality requirements.
Qualification and Experience
Requirements: 2+ years of training or work experience in the health insurance industry (Commercial Insurances, Medicare, Medicaid); health claims billing and/or Third Party contracts. Excellent analytical, fact-finding, problem solving and organizational skills as well as the ability to communicate, both verbally and in writing with staff, patients and insurance plan administrators. Demonstrated ability to work successfully in a team setting. 1+ years of medical billing and/or follow-up experience in Medicare, Medicaid and/or commercial Payer. 6 months working experience with WebCollect, ISeries, Help2, and/or Cirius. Demonstrated knowledge of Federal and State laws pertaining to health insurance (COBRA, HIPAA, ERISA, State Laws, and Fiduciary responsibilities), worker's compensation, subrogation and civil litigation. Experience working with employer benefit plans and their interpretation. Working experience in medical payment research and analysis. Prior Intermountain Healthcare Revenue Cycle Operations (RCO) experience.
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