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Corporate Physician Advisor
1 week ago
Community Health System Franklin, United StatesJob Description · Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 44 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 78 acute-care ...
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General Manager
2 weeks ago
TOCA USA Franklin, United StatesJob Description · Job DescriptionAt TOCA, we are passionate about people and the power of sport. We believe in creating an environment that becomes the "third home" for our guests — where they learn, where they live, and where TOCA becomes the place where they play. Whether they' ...
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Clinical Appeals Specialist II
1 week ago
SSC - Nashville Franklin, United StatesEssential Duties and Responsibilities: include the following.Other duties may be assigned. File medical necessity and level of care appeals using InterQual and CMS guidelines as needed.Monitor clinical appeal processes for issues and trends and provide guidance and feedback to re ...
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Clinical Appeals Specialist II
1 week ago
SSC - Nashville Franklin, United StatesEssential Duties and Responsibilities: include the following.Other duties may be assigned. File medical necessity and level of care appeals using InterQual and CMS guidelines as needed. · Monitor clinical appeal processes for issues and trends and provide guidance and feedback t ...
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Accts Receivable Spclst
2 weeks ago
IASIS Healthcare Franklin, United StatesAccts Receivable SpclstClick Here to Apply OnlineJob DescriptionLocation: Stewardship Health IncPosted Date: 4/16/2024Job Type: Full TimeDepartment: TexasLouisiana Accounts Receivable MCSETPosition Summary:Under the direction of the Manager and Supervisor of Accounts Receivable D ...
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Relations manager non
3 weeks ago
Danita's ChildrenHope for Haiti Children's Center Franklin, United StatesFull job description · About us · We are professional and agile. · Our work environment includes: · Modern office setting · Work-from-home days · Safe work environment · Position Title: · Donor Relations Manager · Reports to: · US Director · POSITION SUMMARY · The Donor Relat ...
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Therapy Office Administrative Assistant
2 weeks ago
National Health Corporation Franklin, United StatesJob Description · Job Description The Therapy Office Administrative Assistant is responsible for performing designated tasks related to the operation of the therapy services in a fast-paced therapy department. Experience in a healthcare setting or medical office administration i ...
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General Manager
1 week ago
TOCA USA Franklin, United StatesJob Description · Job DescriptionAt TOCA, we are passionate about people and the power of sport. We believe in creating an environment that becomes the "third home" for our guests — where they learn, where they live, and where TOCA becomes the place where they play. Whether they' ...
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Assistant Manager
1 week ago
Freeman Webb Company Franklin, United StatesJob Description · Job DescriptionDescription:Job Title · Assistant Manager · Reports To · Community Manager · Supervises Job Title · Trainee or Leasing Consultant as specified by the Community Manager. · Description of Position · The Assistant Manager handles leasing activities i ...
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assistant vice president reimbursement
3 weeks ago
HCA Brentwood, TN, United StatesThis position is incentive eligible. · Introduction · Do you want to join an organization that invests in you as a(an) Assistant Vice President Reimbursement? At HCA Healthcare, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible ...
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Associate Attorney
2 weeks ago
Cole Law Group, P.C. Brentwood, United StatesCompany Description · Cole Law Group, P.C. is a full-service law firm located in Brentwood, TN that provides legal services in various areas such as Family Law, Personal Injury, Business Law, Employment Law, Defamation, Entertainment Law, and Appeals. We pride ourselves in provid ...
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Medical Director
3 weeks ago
Central Boulevard Veterinary Hospital Brentwood, United States· Northern California Medical Director Wanted · Competitive Compensation of $150,000-$250,000 per year + Production Bonus and Medical Director stipend Generous Sign-on Bonus and Relocation Assistance Available · Join us in a fulfilling role as the Medical Director at Central B ...
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Medical Director
3 weeks ago
Central Boulevard Veterinary Hospital Brentwood, United States· Position at Central Boulevard Veterinary Hospital · Northern California Medical Director Wanted · Competitive Compensation of $150,000-$250,000 per year + Production Bonus and Medical Director stipend Generous Sign-on Bonus and Relocation Assistance Available · Join us in a ...
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Talent & People Manager
4 days ago
LEO Events Brentwood, United StatesJob Description · Job title: Talent & People Manager · Department: Human Resources & Administration · Location: Memphis · Reports to: Senior Director, Human Resources & Administration · Supervises: None · FLSA Status: Full time, Exempt · Company Summary: · LEO Events is an award- ...
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Associate Attorney
20 hours ago
Cole Law Group, P.C. Brentwood, United StatesCompany Description · Cole Law Group, P.C. is a full-service law firm located in Brentwood, TN that provides legal services in various areas such as Family Law, Personal Injury, Business Law, Employment Law, Defamation, Entertainment Law, and Appeals. We pride ourselves in provid ...
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Sous Chef
1 week ago
The Governors Club Brentwood, United States· JOB POSTING · Position Title:Sous Chef · Location:The Governors Club, Brentwood, TN · Start Date:May 2024 · Respond To:Lee Spencer · Facility Description: · In 1799, Colonel John Winstead and family first took possession of the rich farmland that would for the next two centu ...
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Sous Chef
1 week ago
The Governors Club Brentwood, United States Full timeMake Life Great We are devoted to having our employees live large significant lives, filled with joy. That means working hard, having fun, and flourishing as an employee and person. People Grow Here Your growth and development are a Gov Club priority. From Kitchen to Dining we ar ...
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Assistant Vice President Reimbursement
3 weeks ago
HCA Healthcare Brentwood, United States Full timeDescription · This position is incentive eligible. · Introduction · Do you want to join an organization that invests in you as a(an) Assistant Vice President Reimbursement? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support ...
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Manager Reimbursement
3 weeks ago
HCA Healthcare Brentwood, United States Full timeDescription · Introduction · Do you want to join an organization that invests in you as a(an) Manager Reimbursement? At HCA Healthcare, you come first. HCA Healthcare has committed up to 300 million in programs to support our incredible team members over the course of three year ...
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Appeals Specialist
3 weeks ago
BlueCross BlueShield of South Carolina Nashville, United StatesJoin our appeals team to performs non-medical reviews and processes redetermination letters. Description CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, h Appeals Specialist, Appeals, ...
Appeals Administrator - Franklin, United States - XSOLIS, Inc.
Description
At XSOLIS, the Appeals Admin work with our clients and client representatives to investigate denied claims, document investigation, and work to effect reimbursement for denied services.
The Appeals Analyst will need a strong understanding of clinical policies, contracts, and regulations to guide research into claim denials.
Aside from the technical know-how, a successful Appeals Analyst will also have the soft-skills necessary to build relationships with clients, payers, and providers and the ability to draft a convincing argument for reimbursement.
Essential Duties & ResponsibilitiesThe essential functions include, but are not limited to the following:
Ability to resolve claims by reviewing supporting documentation; calculating benefits due; initiating payment or composing appeal letters; guiding resolution of non-routine claims; auditing claims to ensure appropriate payment.
Assists in creating reports by securing analytical information through to a finished product
Work with Appeals Analysts to analyze claims to determine validity of denial/recovery options from client inventories and formulate recovery resolution
Clearly and concisely document all actions taken to resolution within a claims recovery system
Provide support to the Appeals team
Familiarity with Microsoft Office products, Access, provider and payer operating systems a plus.
Minimum Qualifications (Knowledge, Skills, and Abilities)
Superior verbal, written, customer service, and analytical skills
Well versed in MS Office Products specifically with Excel advanced proficiency.
Knowledge of reimbursement solutions
Good negotiating skills with problem recognition and resolution skills
Ability to effectively drive several tasks/roles at any given point
Ensures legal compliance by following guidelines, contracts, regulations, and the company's business plan
Maintains quality service by following corporate provider and payer service practices and protocols.
Ability to multi-task and work in a team environment
