About the Role
The Appeals Specialist is responsible for validating employee outputs in various areas including; Claims, Member / Provider Service, Enrollment and regulatory compliance. The Appeals Specialist collaborates with business partners across Operations and external vendors to create and maintain quality policies and processes to assure appeal meets the agreed standards. Sets up and maintains case files for each grievance and collects the information required by organizational policies and applicable regulations. Appeal Resolution Specialist conducts research and coordination needed to evaluate, process, respond to, and refer or close appeals. Department manager would have same job description, but with added supervisory responsibilities.
Minimum of 1 year of experience in Revenue Cycle and Auditing.
1 - 3 years exposure in various departments in a health insurance organization such as; customer service, and/or enrollment, claims and premium billing expedience or equivalent experience is required.
Working knowledge and basic understanding in Claims, Enrollment and Member / Provider, and procedures is required.
About the Company
National Billing Institute located in Boca Raton, Florida, is a full service, practice management company, providing the practice with a comprehensive and cost effective solution to all of your billing needs. Now offering an Electronic Medical Records module ( EHR ). We have over 60 years of medical billing experience, medical billing is not new to us, and we have been a full service billing company for over two decades. We know how to get your claims and bills paid, quickly and efficiently.