Appeals Specialist at GI Alliance – Austin, Texas

Appeals Specialist
Job DetailsJob Location: Hybrid • TDDC Austin CBO - Austin, TX 78758
Position Type: Full Time
Job Shift: Day
Description

Description

Austin Gastroenterology is seeking an experienced Appeals Specialist.

Duties of this position include, but are not limited to, the following:

Position purpose

Responsible for validating dispute reasons following Explanation of Benefits (EOB) review, escalating payment variance trends or issues, and generating appeals for denied or underpaid claims.

Responsibilities/Duties/Functions/Tasks:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Research and resolve claim denials and appeals in accordance to insurance policy, rules and regulations.

Responsible for managing multiple cases simultaneously within specific time frames

Follow up on all returned claims, correspondence, denial, account reconciliation and rebills to achieve maximum reimbursement in a timely manner

Work with all insurance companies to resolve denials to get claims paid

Work within established guidelines when necessary to process appeal for denied requests

Responsible for timely resolution of all claims including corrected claims, appeals and communicating with agency personnel on incorrect payer data

Follow specific payer guidelines for appeals submission

Escalate exhausted appeal efforts for resolution

Perform other duties as assigned.

Qualifications

Qualifications

Education: High school diploma or equivalent
Experience: Minimum of two (2) years of medical billing and collection experience required; prior medical billing denials and appeals processing experience preferred.
Qualifications

Thorough understanding of medical terminology; CPT and ICD10 coding rules.

Excellent written and verbal communication skills

Excellent customer service skills are required

Experience reviewing EOB and UB-04 forms

Ability to multi-task and work in fast-paced environment.

Detail-oriented

Be able to read and understand medical benefits.

Bilingual is a plus.

Additional Qualifications: N/A
Performance Requirements:

Ability to dispute claim payments

Excellent communication skills, both written and verbal.

Proficient technical (computer) skills.

Ability to multi-task and prioritize.

Self-motivated with initiative.

Strong sense of ethics.

Please Note: All job offers are contingent on the successful completion of pre-employment criminal history check.

NOTE: ALL APPLICATIONS MUST BE COMPLETED IN FULL FOR CONSIDERATION.

No phone calls or agencies, please.

EEO/AA-M/F/disabled/protected veteran