What are the responsibilities and job description for the Appeals Assistant position at Charter Healthcare?
POSITION SUMMARY: The Appeals Assistant: Responsible for ensuring professional handling of all provider appeals in a timely, compliant, and efficient way as well as be responsible for the daily office operations, procedures, and resources to facilitate organizational effectiveness and efficiency.
- Under the direction of the assigned supervisor, perform a variety of clerical duties pertaining to the compliance and appeals department.
- Participate in chart reviews and audits.
- Maintain a current knowledge of federal and state regulations, as well as payer specific requirements and take appropriate action as appropriate.
- Manage the receipt, investigation, and resolution of appeals in a timely, compliant, and highly effective manner.
- Receives and performs research on appeals and categorizes each appeal appropriately.
- Communicate with providers in a professional manner, and clearly articulates what information is required for processing appeals.
- Completes data entry and documentation requirements in multiple systems: including correct input of audit universe fields.
- Coordinates with internal departments and external vendors relative to the investigation, review and resolution of an appeal and the research needed to prepare the case for internal and external review.
- Interacts with Managers, Medical Directors, Executive Directors, Case Managers, Legal, Finance, and other areas in facilitating identification and resolution of appeals.
- Assisting with the inner office departments including medical records, human resources, Quality Assurance, or front desk as needed.
- Perform clerical, administrative, and secretarial responsibilities and tasks within the office.
- Monitor, transfer, and guide all telephonic communications to needed departments.
- Allocation of resources to enable task performance.
- Opening, distributing, and managing the mail as needed.
- Maintaining a clean office work environment, including wiping down counters, doors, and taking out trash if necessary.
- Design, implement and ensure that the policies and procedures are created and are adhered to.
- Maintain a safe and secure working environment.
- Fax, record, and monitor paperwork that is faxed in and out of the office.
- All other duties and responsibilities as assigned.
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