- Utilize resources to effectively research denial/requests for additional information
- Evaluate clinical information and supportive documentation prior to payer response
- Prepare persuasive response to request for information or appeal based on supporting clinical information and available studies/research
- Prepare clear and concise persuasive statements of medical necessity from a clinicians perspective
- Monitor denial and appeals information for payor, provider or departmental trends. Routinely report to management regarding trends and recommends process improvement initiatives.
- Generate denial and appeal tracking reports for management and departments
- Maintain compliance with all appropriate regulatory requirements including HIPAA
- Other duties and projects as assigned
- Bachelors degree or equivalent relevant work experience
- 1-3 years experience writing commercial payer claim appeals
- 1+ years of commercial billing experience
- Clinical background
- Previous experience in medical device industry or health insurance
- Experience with Brightree software
- Experience with Microsoft Word, Excel, and Outlook
- Understanding of health insurance methodologies (coding, coverage, prior authorizations, clinical criteria and payments)
- Exceptional attention to detail and written communications skills with emphasis on persuasion and clinical knowledge
- Excellent analytical and research skills
- Strong strategic thinking ability with bias towards action/execution
- Ability to organize and manage workload with limited oversight
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Claim Appeals Specialist - Minneapolis, United States - Tactile Medical
Description
Overview:
The Claim Appeals Specialist is responsible for researching and addressing claim issues related to medical necessity in which a request for additional information or denial of payment has been received. This position works closely with payers and our Billing and Collections teams to effectively address the denial/request for additional information with supporting clinical information and persuasive writing in effort to secure reimbursement.
Responsibilities:Education & Experience
Required:
Preferred:
Knowledge & Skills
$ $30.69 / HR
Additional benefits::
Non-Exempt - Our total compensation package includes medical, dental and vision benefits, retirement benefits, employee stock purchase plan, paid time off, parental leave, family medical leave, volunteer time off and additional leave programs, life insurance, disability coverage, and other life and work wellness benefits and discounts. Benefits may be subject to generally applicable eligibility, waiting period, contributions, and other requirements and conditions.
