Medical Billing/ AR and Appeals Specialist

Job purpose

• The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.

Duties and responsibilities

• Reviews and appeal unpaid and denied claims
• Attaches appropriate documents to appeal letters
• Researches and evaluates insurance payments and correspondence for accuracy
• Logs appeals and grievances, and tracks progress of claims
• Keeps up-to-date reports and notates any trends pertaining to insurance denials
• Calls insurance companies to inquire about claims, refund requests and payments
• Manages Accounts Receivable reports for the Billing Department
• Utilizes EMR system to submit and correct claims
• Posts patient and insurance payments
• Sends paper claims to insurance carriers
• Answers patient billing questions
• Coordinates medical and billing records payments with patients and/or third-party payers
• Handles collections on unpaid accounts
• Identifies and resolves patient billing complaints
• Answers phone calls to the Billing Department in a timely and professional manner
• Processes credit card payments over the phone and in person
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
• Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
• Has regular and predictable attendance
• Adheres to Advanced Pain Care’s Policies and procedures
• Performs other duties as assigned