Appeals Specialist jobs in the United States

Appeals Specialist
  • Advanced Pain Care
  • Austin, TX FULL_TIME
  • Description

    Job purpose

    • The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.

    Duties and responsibilities

    • Reviews and appeal unpaid and denied claims
    • Attaches appropriate documents to appeal letters
    • Researches and evaluates insurance payments and correspondence for accuracy
    • Logs appeals and grievances, and tracks progress of claims
    • Keeps up-to-date reports and notates any trends pertaining to insurance denials
    • Calls insurance companies to inquire about claims, refund requests and payments
    • Manages Accounts Receivable reports for the Billing Department
    • Utilizes EMR system to submit and correct claims
    • Posts patient and insurance payments
    • Sends paper claims to insurance carriers
    • Answers patient billing questions
    • Coordinates medical and billing records payments with patients and/or third-party payers
    • Handles collections on unpaid accounts
    • Identifies and resolves patient billing complaints
    • Answers phone calls to the Billing Department in a timely and professional manner
    • Processes credit card payments over the phone and in person
    • Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
    • Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
    • Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
    • Has regular and predictable attendance
    • Adheres to Advanced Pain Care’s Policies and procedures
    • Performs other duties as assigned



    Education: Requires a high school diploma or GED

    Experience: Three or more years related work experience of training

    Knowledge, Skills and Abilities:

    • Clear and precise communication
    • Ability to pay close attention to detail
    • Effectively manages day by organizing and prioritizing
    • Possesses excellent phone and customer service skills and abilities
    • Protects patient information and maintains confidentiality
    • Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
    • Familiarity with analyzing electronic remittance advice and electronic fund transfers
    • Experience interpreting zero pays and insurance denials
    • Competence in answering patient questions and concerns about billing statements
    • Organizational skills and ability to identify, analyze and solve problems
    • Works well independently as well as with a team
    • Strong written and verbal communication skills
    • Interpersonal/human relations skills

    Working conditions

    Environmental Conditions: Medical Office environment

    Physical Conditions:

    • Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
    • Must be able to sit and/or stand for prolonged periods of time
    • Must be able to bend, stoop and stretch
    • Must be able to lift and move boxes and other items weighing up to 30 pounds.
    • Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.
  • 16 Days Ago

Appeals Specialist
  • Halifax Health
  • Daytona Beach, FL FULL_TIME
  • Overview Halifax Health is seeking an Appeals Specialist for the PBFS - Administration Department. Summary The Appeals Specialist is responsible for monitoring and tracking the status of appeals submi...
  • 17 Days Ago

Appeals Specialist
  • Blue Cross & Blue Shield of Mississippi
  • Cross, MS FULL_TIME
  • Healthy Careers Start Here At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellnes...
  • 18 Days Ago

Appeals Specialist
  • Unified Group Services
  • Anderson, IN FULL_TIME
  • Unified Group Services is a full-service third-party administrator (TPA) for self-insured group health plans. We're dedicated to providing excellent customer service and the flexibility our customers ...
  • Just Posted

  • UHS
  • Responsibilities 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...
  • 9 Days Ago

Appeals Specialist
  • Independence Blue Cross Careers
  • Philadelphia, PA FULL_TIME
  • The Appeals Specialists investigates the appeal requests, gathers all pertinent information to ensure the appeals committee can provide an accurate and fair determination. Completes the determination ...
  • 21 Days Ago

Cybersecurity Subject Matter Expert
  • IT Concepts, Inc
  • Woodlawn, MD
  • Founded in 2003, IT Concepts' core values - customer-centricity, teamwork, driven to deliver, innovation, and integrity ...
  • 5/21/2024 12:00:00 AM

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  • Resource Management Concepts, Inc.
  • Quantico, VA
  • Resource Management Concepts, Inc. (RMC) provides high-quality, professional services to government and commercial secto...
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  • Tyto Athene
  • Washington, DC
  • Job Description Tyto Athene is seeking a VTC Subject Matter Expert to support our offices in DC and VA. What You Will Be...
  • 5/21/2024 12:00:00 AM

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  • Bering Straits Native Corporation
  • Arlington, VA
  • Overview Visit our website at to apply! Equal Opportunity Employer/Veterans/Disabled SUMMARY Parag...
  • 5/21/2024 12:00:00 AM

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  • Bering Straits Native Corporation
  • Arlington, VA
  • Overview Visit our website at to apply! Equal Opportunity Employer/Veterans/Disabled SUMMARY Parag...
  • 5/19/2024 12:00:00 AM

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  • Kepler Research, Inc.
  • Woodbridge, VA
  • Acquisition and Program Management Subject Matter Expert supporting the Missile Defense Agency (MDA), Director of Acquis...
  • 5/18/2024 12:00:00 AM

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  • Bering Straits Native Corporation
  • Arlington, VA
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Semiconductor Subject Matter Expert
  • Corner Alliance
  • Washington, DC
  • Corner Alliance is a dynamic, growing consulting firm that devotes itself to providing an enriching employee experience ...
  • 5/17/2024 12:00:00 AM

Income Estimation for Appeals Specialist jobs
$47,789 to $59,201