Medical Billing - Revenue Cycle - Appeal Determination - Medicare - On-Site or Remote

Medical Billing - Revenue Cycle - Appeal Determination - Medicare

On-Site or Remote

Starting Pay $18.00

The Appeal Determination - Medicare position is responsible for reviewing incorrectly processed and/or denied claims to determine next appropriate actions to resolve the claim.

Essential Functions/Duties

• Effectively process remittance advice notices from Medicare claims (primary, secondary, tertiary) to determine next actions.

• Obtain and document necessary reprocessing and/or appeal related data to resolve the incorrectly processed/denied claim in a timely and efficient manner.

• Assure process and resources are allocated to provide required payor documentation assembly and filing in a timely manner.

• Analyze work processes to maximize efficiency.

• Work to achieve team and departmental goals.

• Work effectively as a member of a team.

• Communicate clearly and concisely, both orally and in writing.

Qualifications:

Required Experience

• Must be fluent in English

• Minimum three (3) years experience in healthcare/revenue cycle billing environment

• Above average knowledge of Medicare and/or Medicare Replacement billing guidelines

• Ability to read and decipher an explanation of benefits and/or remittance advice notice

• Minimum of one (1) year working in a call center environment

• Ability to work independently or as an active member of a team

• Must possess empathic and professional written and verbal communication skills

• Knowledge and experience of computers and related technology, at an intermediate level

Preferred Experience

• A minimum of one (1) year working in a customer service

Education

• High school diploma or equivalent

Skills:

• Knowledge of health care billing procedures, reimbursement, third party payer regulations, documentation, and standards

• Knowledge of health care billing compliance regulations

• Knowledge and understanding of payor Explanation of Benefits (EOB)/ Remittance Advice (RA) notice

• Requires strong problem-solving skills, attention to detail, and ability to make timely decisions

• Intermediate computer skills and familiarity with Microsoft Office, especially Excel

• Ability to adapt to change

• Above average internal and external customer service skills

• Responsiveness and a strong commitment to meeting internal and external deadlines with limited supervision

• Above quantitative, analytical, and problem-solving skill

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EEO Statement

Global Medical Response and its family of companies are an Equal Opportunity Employer, which includes supporting veterans and providing reasonable accommodations for individuals with a disability.