The Appeals Representative Team Lead is responsible for addressing provider inquiries and appeals via email, fax, telephone, or written correspondence ensuring adherence to client policy, industry standards along with CMS and state guidelines as well as client instructions.
ESSENTIAL FUNCTIONS & RESPONSIBILITIES :
- Reviews, analyzes, and completes appeals in accordance with client policy, CMS guidelines and industry standards in clear and professional written communication
- Ability to appropriately interpret provider appeals and apply analytical thinking skills
- Ability to interpret client policy and CMS guidelines as it relates to reviews done by CERiS such as itemized bill
- Utilize applicable tools and resources to complete appeals
- Timely completion of appeals
- Additional duties as assigned
KNOWLEDGE & SKILLS :
Prior knowledge of inpatient and outpatient hospital revenue cycle requiredExcellent written and verbal communication skillsContract interpretation, medical terminology and coding knowledgeProficiency with Microsoft applicationsEDUCATION & EXPERIENCE :
High school diploma or equivalent3+ years of healthcare revenue cycle experience (collections, appeals, denials management, etc)2+ years working with customers in a fast-paced, deadline-oriented environment2+ years experience as an Appeals RepresentativeStrong attention to detail, organizational and time management skills with the ability to interpret, research and identify core issuesStrong customer focus, analytical and decision making skillsStrong technical skills with the ability to work across multiple software systems and comfortable working remotely out of your homeJ-18808-Ljbffr