Remote Appeals Support Representative

Customer Service
  • Customer Service
  • Chicago, IL
  • Salary: TBD

Aston Carter

Fully Remote Opportunity Description: 90% Phone work!! Be able to identify different types of hospital documentation including, but not limited to, medical records, UB-04s, EOBs, Itemized Bills, Hospital Account notes, appeal letters, and denial/approval letters.

Utilize software system to obtain work assignments and communicate with other employees in a clear and concise manner. Be able to identify a payment posted in a healthcare system, retractions and date of posting. Maintain an understanding of how to utilize a multitude of hospital patient accounting systems (i.e.; Epic, Meditech, Eagle, and Paragon) to accurately identify payments and retractions. Print and review a high volume of payment histories per day; approximately 500. Work closely with staff responsible for all aspects of payment verification to ensure all provider systems are trolled in accordance with the weekly trolling schedule. Be proficient in common notation practices within the healthcare system. This includes, but is not limited to payments, adjustments, retractions, billings, notes, etc. Post received payments in software system and appropriate spreadsheets for accurate billing of clients. Navigate through payer portals to submit appeals, documentation and inquiries to the plan. Timely follow up on the status of all submissions via the portal. Notify the appropriate staff on the status of portal submissions. Submit responses to insurers via the portal. Utilize provider systems to obtain necessary documentation for case files based on requests from employees. Resolve, call, inquire and/or appeal a defined number of accounts per day as instructed leadership. Draft appeals and letters to insurance companies. Make proper notations in software system on all accounts. Understand and utilize payer contracts and provider manuals when disputing denials. Use proper approved note structure when notating all accounts. o Insurance company name @ number dialed | First name and last initial of the representative spoken to. (Ex. Aetna @ 1-800-624-0756 | John S.) Follow up on all appeals, claims, letters or other documentation within 20 days or less of the submission. Follow up on all payments at the time an overturn letter is received. Demonstrate an understanding of office workflow by completing necessary required fields correctly. Ensure that assigned accounts are appealed timely through the use of an internal worklist. Maintain worklist through daily audits and the open task report.

Ensure that all assigned cases have a follow up and that there are no duplicate follow ups. Address all follow ups promptly. o Alerts must be addressed within a day of receipt. o Initial call requests must be addressed within two days from the receipt of the follow up. o Follow ups should never be more than 14 days old. Handle RUSH cases appropriately. o A RUSH is any appeal or submission that is due within two weeks from the date the due date was verified. Maintain one follow up in each assigned account and refrain from unnecessary duplicate follow ups on worklist. Obtain prior approval from a Lead, Supervisor, or Manager for all modifications to a UB-04; including, but not limited to, additions, changes or removals to/from the original claim provided by the facility. Meet all weekly performance standards and goals set by leadership. Perform general office duties such as typing, scanning, operating office machines, and sorting documentation. Identify and communicate appeal deadlines to appropriate staff. Handle rush and high balance cases in accordance with office policy. Follow all HIPAA guidelines in accordance with Employee Handbook. Skills: data entry, attention to detail, medical claim, medical billing, epic, quantum, medical record Top Skills Details: data entry,attention to detail,medical claim,medical billing Additional Skills & Qualifications: MUST HAVES: – Associates or technical degree; OR one to two years related experience and/or training; or equivalent combination of education and experience. – Medical billing experience in a healthcare setting – Experience working fast-paced work environment – HIGH attention to detail NICE TO HAVES: – Experience with EMR, EPIC or Quantum systems – Experience calling insurance companies for follow up -Call Center Experience Experience Level: Intermediate Level

About Aston Carter: At Aston Carter, we’re dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions – from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients’ capabilities by seeking solvers and delivering solutions to address today’s workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit AstonCarter.com. Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call 888-237-6835 or email [email protected] (%[email protected]) for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.

Aston Carter

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Chicago, IL

60684 USA

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Legal

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