What are the responsibilities and job description for the APPEALS SPECIALIST position at TMC Bonham Hospital?
Responsibilities:
The Appeals Specialist is responsible for appealing all insurance denials and prepare relevant reports regarding trends in denials. Demonstrate the ability to ensure accurate and timely appeals to third party payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety of resources including but not limited to hospital/physician billing systems, external contract/claims management and work with departmental personnel.
Qualifications:
Must possess a strong knowledge of clinical documentation, Medicare rules and regulations; excellent interpersonal communication and problem solving skills necessary to gather and exchange data ( both internally and externally) with key medical and third party professionals; experience with Microsoft Office and internet websites.
EEO Statement
Notice
TMC Bonham Hospital is a 25-bed critical access hospital that includes both primary care and specialty physicians. The Critical Access Hospital, offering both inpatient and outpatient services along with 24-hour emergency services. The Critical Access Hospital (CAH) Program was established to assure access to healthcare services for rural residents. The program provides rural acute care hospitals with a range of opportunities for service enhancement and quality of care improvement. Quality healthcare and patient safety is our goal. Delivering the right care at the right time in the right setting is the core mission of a critical access hospital. We are committed to improve the quality of care we deliver every day. TMC Bonham is managed by Texoma Medical Center, subsidiary of UHS.
The Appeals Specialist is responsible for appealing all insurance denials and prepare relevant reports regarding trends in denials. Demonstrate the ability to ensure accurate and timely appeals to third party payers in compliance with Managed Care contracts and government fee schedules. The Appeals Specialist will obtain, manipulate, and analyze data from a variety of resources including but not limited to hospital/physician billing systems, external contract/claims management and work with departmental personnel.
Certification in medical coding and billing preferred.
2-3 years of experience in customer service, healthcare appeals processing or insurance industry
Must possess a strong knowledge of clinical documentation, Medicare rules and regulations; excellent interpersonal communication and problem solving skills necessary to gather and exchange data ( both internally and externally) with key medical and third party professionals; experience with Microsoft Office and internet websites.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws. We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: https://uhs.alertline.com or 1-800-852-3449.
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