What are the responsibilities and job description for the Appeals Specialist I position at Physicians Regional Healthcare System?
Job Description
Essential Duties and Responsibilities
(List in order of importance or percentage of time spent on the particular responsibility – High to Low
Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals and communicates daily with Sr. Director/Manager on trends identified
Responds to queries within 72hrs, appropriately documents in Cerner/ClaimIQ/Artiva, and tracks all activity in the Appeal Tracker.
Manages PDFU to assure timely follow-up of accounts to effectively move through the revenue cycle
Completes claim appeals and assists with other projects, as needed.
Submits requests for medical records, ub’s, and itemized bills as needed.
Responsible for being aware of the current department policies and procedures
Meet or exceed quality and quantity benchmark targets as established by management (productivity, AR days, Cash Collections, Bad Debt, Past Due Follow Up)
Ability to perform all other duties as assigned or requested
Ensure confidentiality of all patient accounts by following HIPAA guidelines
INDSS
Essential Duties and Responsibilities
(List in order of importance or percentage of time spent on the particular responsibility – High to Low
Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals and communicates daily with Sr. Director/Manager on trends identified
Responds to queries within 72hrs, appropriately documents in Cerner/ClaimIQ/Artiva, and tracks all activity in the Appeal Tracker.
Manages PDFU to assure timely follow-up of accounts to effectively move through the revenue cycle
Completes claim appeals and assists with other projects, as needed.
Submits requests for medical records, ub’s, and itemized bills as needed.
Responsible for being aware of the current department policies and procedures
Meet or exceed quality and quantity benchmark targets as established by management (productivity, AR days, Cash Collections, Bad Debt, Past Due Follow Up)
Ability to perform all other duties as assigned or requested
Ensure confidentiality of all patient accounts by following HIPAA guidelines
INDSS
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