Appeals Representative

Revenue Cycle Management
Massachusetts, Wilbraham
Posted 1 month ago

POSITION SUMMARY

An Appeals Representative will accomplish follow-up on billed professional fee charges.  This person also will research unbilled charges and perform necessary action to become billed timely. They will research and correct denied claims and provide feedback to billers and Supervisor on process improvement. This person will also complete Secondary/Tertiary billing, perform daily tasks as directed, and assist with professional billing customer service.

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Perform follow-up either on website or placing phone calls to Insurance Carrier or patient with unpaid claims
  • Navigate effectively and efficiently through insurance websites
  • Verify insurance eligibility and benefits; obtain LCD’s/Carrier Policies
  • Research credit balances providing feedback and/or prepares refunds for approval by Supervisor
  • Process correspondence requests; respond to customer inquiries in a timely manner
  • Provide weekly review of rejected claims and find resolutions
  • Identify and escalate trends; share ideas for process improvement
  • Correspond with department on inquiries and deficiencies
  • Work denied claims reports and outstanding claims reports in the allotted time period per departmental protocol
  • Perform other duties as assigned

QUALIFICATIONS (Knowledge, Skills, and Ability Requirements)

  • 2+ years of professional/medical billing experience
  • Effectively communicate with physician’s clients and staff employees
  • Computer literacy: basic Word processing and Excel skills
  • Detail oriented
  • Ability to effectively handle multi tasks at once
  • Self-directed

GBS Convergent Solutions is an equal opportunity and affirmative action employer. We consider all qualified applicants for employment without regard to race, color, religion, creed, national origin, sex, pregnancy, age, sexual orientation, transgender status, gender identity, disability, alienage or citizenship status, marital status or partnership status, genetic information, veteran status or any other characteristic protected under applicable law.

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