Appeals Specialist I - Sarasota, United States - SSC - Sarasota

Description

Essential Duties and Responsibilities

(List in
order of importance or percentage of time spent on the particular responsibility -
High to
Low

1.

Manages workflow for Humana PPI Audits, RAC Audits, or Outpatient Appeals and communicates daily with Sr. Director/Manager on trends identified

2.

Responds to queries within 72hrs, appropriately documents in Cerner/ClaimIQ/Artiva, and tracks all activity in the Appeal Tracker.

3.

Manages PDFU to assure timely follow-up of accounts to effectively move through the revenue cycle

4.

Completes claim appeals and assists with other projects, as needed.

5.

Submits requests for medical records, ub's, and itemized bills as needed.

6.

Responsible for being aware of the current department policies and procedures

7.

Meet or exceed quality and quantity benchmark targets as established by management (productivity, AR days, Cash Collections, Bad Debt, Past Due Follow Up)

8.

Ability to perform all other duties as assigned or requested

9.

Ensure confidentiality of all patient accounts by following HIPAA guidelines


INDSS