Alliance Family of Companies

  • Appeals Specialist

    Job Locations US-TX-Irving
    Posted Date 1 month ago(9/24/2018 11:03 AM)
    Job ID
    2018-2529
    # of Openings
    1
  • Alliance Family of Companies

    In business since 2006, Alliance Family of Companies was recently named one of the fastest growing, privately held companies in America by INC 500 for the third year in a row! Headquartered in Irving, Texas we are the largest Sleep and EEG testing company in the country.  We strive to condense the patient care cycle, allowing for strong physician relationships and better patient experiences. Come be a part of a unique vision and company!

     

    Benefits Offered

    • 401(k) with company match
    • Comprehensive benefits package
    • Highly competitive compensation
    • On-site workout studio with trainers M-F
    • Employee education assistance
    • PTO and paid Holidays

    Essential Duties

    The Appeal Specialist is responsible for reviewing denied claims, gathering data to support appeals and exhausting all avenue of appeal prior to having to resort to writing off a claim.  Reporting to the Director of Revenue Cycle Management, the Appeal Specialist is tasked with minimizing the number of claim write offs.

    General Job Responsibilities

    • Manage denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care
    • Review clinical information for all appeals by using criteria that are nationally recognized, in order to determine the actual necessity of the services that are requested
    • Prepare appeals for cases meeting the required criteria
    • Coordinate and deliver verbal and written information regarding appeals and ensure all letters are in line with all required standards
    • Create appeal templates for bulk issues
    • Summarize clinical documentation for legal referrals
    • Train RCM staff members on clinical related issues
    • Maintain NCD/LCD/Medical Policy Criteria for major payers impacting the business
    • Proactively manage denial prevention
    • Ensure compliance with HIPAA regulations, to include confidentiality, as required
    • Perform other duties as assigned

    General Job Requirements

    • High School Diploma or equivalent is required
    • Minimum of 3 years’ experience in the clinical claims appeal process
    • Knowledge of insurance rules and regulations
    • Proficiency in Microsoft Office - especially Excel and Word
    • Proficiency in claim review and appeals processes
    • Strong communication, problem solving and analytical skills
    • Familiar with HIPAA guidelines and procedures
    • Ability to work independently and adapt to a fast paced environment
    • Strong attention to detail with an eye for accuracy
    • Creative, self-disciplined and capable of identifying and completing critical tasks with a sense of urgency
    • Excellent customer service skills
    • Superior written and verbal communication skills

     

    Alliance Family of Companies is an Equal Opportunity Employer

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