- Logs, tracks, and processes appeals and grievances
- Review and stay current with payer and regulatory requirements and communicate changes to team and leadership
-
Appeals Specialist
1 week ago
Blue Cross Blue Shield 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 Specialist
2 weeks ago
BlueCross BlueShield of South Carolina Nashville, United StatesWhy should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades weve been part of the national landscape, with our roots firmly embedded in the South Carolina community Appeals Specialist, Appeals, S ...
-
Appeals Specialist
2 weeks ago
Blue Cross and Blue Shield Association Nashville, United StatesSummary · Join 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, health care provi ...
-
Appeals Specialist
4 days ago
BlueCross BlueShield of South Carolina Nashville, United StatesSummary · Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the larges ...
-
Appeals Specialist
2 weeks ago
Parallon Brentwood, United StatesDescription · Introduction · Are you looking for a work environment where diversity and inclusion thrive? Submit your application for our Appeals Specialist opening with Parallon today and find out what it truly means to be a part of the HCA Healthcare team. · Benefits · Para ...
-
Appeals Specialist
1 week ago
Parallon Franklin, United StatesDescription · Introduction · Do you want to join an organization that invests in you as an Appeals Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. · Bene ...
-
Clinical Appeals Specialist II
1 day ago
Community Health System Antioch, United StatesJob Description · Essential 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 ...
-
Banking Center Manager II
2 weeks ago
First Horizon Bank Nashville, United States Full timeLocation: Onsite in Nashville, TN · Summary · The Banking Center Manager manages all banking center employees and supervises day-to-day operations of the banking center while ensuring safety, operational soundness and excellent service levels. This position is also responsible fo ...
-
Denial Coding Review Specialist
1 day ago
HCA Nashville, United StatesIntroduction · Do you want to join an organization that invests in you as a Denial Coding Review Specialist? At Parallon, you come first. HCA Healthcare has committed up to $300 million in programs to support our incredible team members over the course of three years. · Benefits ...
-
Revenue Cycle Management Specialist
2 weeks ago
Honest Medical Group Nashville, United StatesJob Description · Job DescriptionWho You AreYou are devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of your patients. You are passionate about getting to the root cause of a patient's conditions, removing social determinants of healthc ...
-
Gastroenterology Physician
2 weeks ago
Tristar Health Nashville, United StatesDescription · Specialization: · Gastroenterology · Job Summary: · TriStar Southern Hills Medical Center is seeking a qualified Gastroenterologist to join their existing employed practice in Nashville, Tennessee. · Qualified Candidates:Board certified/Board Eligible in Gastroente ...
-
Apartment Groundskeeper Needed
1 week ago
Career Strategies - Nashville Nashville, United StatesJob Description · Job DescriptionHiring Groundskeepers for Nashville and surrounding areas · The Groundskeeper ensures the physical aspects of the community are maintained and standards are met regarding the grounds, amenities, and overall curb appeal. Groundskeepers also provide ...
-
Inpatient Lead Coder
2 days ago
All Med Search Nashville, United StatesJob Description · Job DescriptionActively participates in the review and improvement of processes and services · Responsible for analyzing weekly/monthly quality data to identify trends by vendor and coder/auditor that need to be addressed · Prepares and presents coder education ...
-
Billing Specialist
2 weeks ago
Diversity Health Nashville, United StatesJob Description · Job DescriptionAt Diversity Health, we are passionate about changing the face of healthcare in Nashville by supporting healthcare clinics such as Music City PrEP Clinic and Chosen Family Medicine. These clinics provide access to biomedical interventions and serv ...
-
Senior Manager, SALT
2 weeks ago
KPMG Nashville, United StatesAt KPMG, you can become an integral part of a dynamic team at one of the world's top tax firms. Enjoy a collaborative, future-forward culture that empowers your success. Work with KPMG's extensive network of specialists & enjoy access to our Ignition Centers, where deep industry ...
-
Housekeeper - The Scottie
1 week ago
RangeWater Real Estate Nashville, United StatesJob Description · Job Title: Housekeeper / Porter · Department: Maintenance · Reports To: Community Director and Service Director · FLSA Status: Non-Exempt · Position Summary: Meets standards regarding the appearance of the interior physical features of the community by perf ...
-
Groundskeeper
4 weeks ago
Gallery Residential Nashville, United StatesJob Description · Job DescriptionJob Title: Groundskeeper · Department: Maintenance · Reports To: Community Director and Service Director · FLSA Status: Non-Exempt · Position Summary: Meets standards regarding the appearance of the exterior physical features of the community by p ...
-
Revenue Cycle Management Specialist
3 weeks ago
Honest Medical Group Nashville, United StatesWho You Are · You are devoted, compassionate, and enjoy being on the front lines in healthcare, changing the lives of your patients. You are passionate about getting to the root cause of a patient's conditions, removing social determinants of healthcare, and ensuring the highest ...
-
Heritage Medical Associates Nashville, United States Part timeJob Details · Job Location · Main Office (MO - 222 MOB) - Nashville, TN · Remote Type · Fully Remote · Position Type · Part Time Weekly Hours) · Education Level · High School Diploma · Travel Percentage · None · Job Shift · Day · Job Category · Health Care · Descrip ...
-
Business Development Representative
3 weeks ago
National Corporate Housing Nashville, United StatesBusiness Development Representative · Ensure all your application information is up to date and in order before applying for this opportunity. · National Corporate Housing is looking for an entry level, outside sales representative to sell all National Corporate Housing Service ...
Medical Necessity Appeals Specialist - Nashville, United States - Integrated Oncology Network, LLC
Description
Partnering With Physicians To Provide Best In Class Patient CareFounded in 2002, Integrated Oncology Network is committed to helping our physicians deliver the right care, at the right time and in the right setting. We strongly believe that preserving the independent practice of medicine where patients are cared for closer to home and surrounded by our dedicated clinicians yields better outcomes. By creating a care continuum between our clinicians, patients and their support networks we deliver an unparalleled approach to the patient's care journey.
The Medical Necessity Appeals Specialist is responsible for appealing denials with supporting medical justification to
overturn payer decisions resulting in claim payment and educate center/billing staff to prevent future denials.
Essential Functions:
•Conducts the medical review activities needed to resolve and process clinical appeals and claims.
•Understands and interprets applicable medical terminology, clinical procedures, regulations and policies. Construct effective appeal letters using medical justification to support appropriate reimbursement
•Reviews applicable medical records and assesses clinical data to investigate and resolve disputes over the medical necessity for services, approvals, pre-certifications, or other cases
•Prepares the documentation required for further medical review, hearings, and different appeal processes
•Sets up and maintains case files for each grievance and collects the information required by organizational policies and applicable regulations
•Conducts research and coordination needed to evaluate, process, respond to, and refer or close appeals
•Works closely with insurance carriers for reimbursement requirements/opportunities to ensure payment in challenging situations
•Identify denial and AR trends to address consistent issues
•Support management with special projects and process improvements
•Work is generally independent and collaborative in nature
•Regular attendance and punctuality
•Perform any other functions as required by management
Qualifications and Education Requirements
•Minimum 5 years of experience in Revenue Cycle
•Education including RHIA, RHIT, CPC, CCS, or nursing degree
•Superior written and verbal communication skills
•Understanding of managed care contracts and fee schedules, including Medicare and Medicaid
•Experience reviewing patient medical records to review conditions of coverage
•Experience with computerized billing software, EMR, clearinghouses and interpreting paper and electronic EOBs
•Working knowledge of ICD-10, HCPCS, and CPT coding
Preferred Skills
•Bachelor's Degree preferred
•Experience with multiple billing systems and EMR
•Proficiency in CPT, HCPCS and ICD 9 and 10 coding
•Proficient in Microsoft Office to include Excel, Word, PowerPoint, and Outlook
•Oncology billing
Required Competencies
Ability to work in a team environment and enjoy multi-job functions. Strong Business and Organizational Competence. Exceptional Customer Service Skills. Strong functional Competence. Interpersonal Skill Competency. Stress Tolerance. Initiative. Adaptability. Accountability. Integrity. Self-Confidence. Time Management Skills with an emphasis on multi-tasking.
Physical Demands and work environment
The physical demands and work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Physical demands: Required job duties are essentially sedentary in nature, consisting of occasional walking, standing, lifting and/or carrying ten pounds maximum, seeing, speaking and hearing. Must be able to lift up to 25 pounds.
Work environment: Required job duties are normally performed in a climate-controlled office environment.
