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Appeals Claims Specialist
- Job ID
- Appeals and Denials
About The Company
At MedData, we take great pride in our company, in each other, and in our 30+ year history of accomplishments and success. This pride is reflected in our everyday approach to working together. Each team member understands the importance of being part of a company that values their individual contributions and strives to help them achieve their personal goals as they work together to achieve the broader corporate goals. We believe that every team member contributes directly to MedData’s growth and success, and we are constantly searching for new talented, passionate and enthusiastic people who will take pride in being an integral part of our culture.
MedData has an excellent career opportunity available as a Claims Specialist - Appeals to work in an office setting located in The Woodlands, TX. The schedule for this full time role is Monday- Friday 8am-5pm.
The purpose of this position is to review, submit and follow up on claims or medical bills for the Billing and Appeals Department. It is the primary responsibility of the Claims Specialist to ensure that claims are submitted timely, that they are processed accurately and, if required, denied services are appealed appropriately.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
- Review and research insurance claims to determine possible payment source(s)
- Contact various sources including insurance professionals, patients, and other parties to verify relevant data
- Coordinate with payors to ensure appropriate filing guidelines are met for reimbursement
- Request appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition
- Maintain and update payors on denied claims
- Ensure that appropriate billing guidelines and standards are met based on payor and/or State
- Perform aggressive follow up on unresolved claims and facilitate payment from appropriate payors
- Responsible for obtaining claim status and gathering supporting documentation to submit appeals
- Assist with written or verbal appeals to payors on denied claims
- Assist in defending the hospital’s or medical provider’s rights to recovery against insurance companies
- Interact with hospital staff members to obtain appropriate documentation for claims and appeals submission
QUALIFICATIONS AND REQUIREMENTS:
- High School Diploma or GED, some college coursework preferred
- 1-2 years of related experience in the healthcare field or in a related area is preferred
- Ability to communicate effectively verbally and in writing and be able to speak professionally with patients and insurance companies
- Ability to proactively resolve issues
- Creative problem solving skills
- Ability to organize and set priorities according to situation all demands
- Required computer skills: must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, and understand how to navigate through web-based applications
MedData believes in making a positive impact not only within our industry but also with our employees –the organization’s greatest asset. We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.
Just some of the benefits we offer:
- HSA, FSA
- Paid Time Off and 7 Paid Holidays
The physical demands 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.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,000 employees and growing, please apply directly to this posting.
MedData is an Equal Opportunity Employer