Elevate Patient Financial Solutions has an excellent career opportunity available as an Appeals and Denials Claims Specialist to work in a remote-based role. The schedule for this full-time role is Monday- Friday 8am -4:30pm. The schedule may vary at times due to client needs and coverage.
Job Summary
The purpose of this position is to review, submit and follow up on claims or medical bills for the Billing and Appeals Department. It is the primary responsibility of the Appeals and Denials Claims Specialist to ensure that claims are submitted timely, that they are processed accurately and, if required, denied services are appealed appropriately.
Essential Duties and Responsibilities
- Review and research insurance claims to determine possible payment source(s)
- Contact various sources including insurance professionals, patients, and other parties to verify relevant data
- Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement
- Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition
- Maintain and update payors on denied claims
- Ensure that appropriate billing guidelines and standards are met based on payor and/or State
- Perform aggressive follow up on unresolved claims and facilitate payment from appropriate payors
- Responsible for obtaining claim status and gathering supporting documentation to submit appeals
- Assist with written or verbal appeals to payors on denied claims
- Assist in defending the hospital’s or medical provider’s rights to recovery against insurance companies
- Interact with hospital staff members to obtain appropriate documentation for claims and appeals submission
Qualifications and Requirements
- High School Diploma or GED, some college coursework preferred
- 1-2 years of related experience in the healthcare field or in a related area is preferred
- Ability to communicate effectively verbally and in writing and be able to speak professionally with patients and insurance companies
- Ability to proactively resolve issues
- Creative problem-solving skills
- Ability to organize and set priorities according to situation all demands
- Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications
- Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.
Benefits
Elevate PFS believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset! We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.
- Medical, Dental & Vision Insurance
- 401K (100% match for the first 3% & 50% match for the next 2%)
- 15 days of PTO
- 7 paid Holidays
- 2 Floating holidays
- 1 Elevate Day (floating holiday)
- Pet Insurance
- Employee referral bonus program
- Teamwork: We believe in teamwork and having fun together
- Career Growth: Gain great experience to promote to higher roles
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, location, specialty and training. This pay scale is not a promise of a particular wage.
The job description does not constitute an employment agreement between the employer and Employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Salary Negotiation
