Medical Billing and Appeals Specialist - Hybrid

Description REMOTE - this position will be fully remote after training. **Texas residents only*** 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 Requirements Qualifications Education: Requires a high school diploma or GED Experience: Three or more years related work experience with medical billing/ claims Previous use of Athena required 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.