Appeals Specialist
New
G
GeneDxGenomics Healthcare
Remote, Ability to support EST hours.Full-TimeMiddle
Salary31.25 - 33.65 USD per hour
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Job Details
- Experience
- 3-5 years of experience in laboratory billing appeals.
- Required Skills
- Microsoft OfficeHIPAA
Requirements
- 3-5 years of experience in laboratory billing appeals.
- Strong understanding of insurance policies, healthcare regulations, medical terminology, and coding.
- Expertise in appeals process for major insurance plans, Medicaid, and Managed Medicaid.
- Knowledge of industry regulations, including HIPAA.
- Proficiency in Microsoft Office Suite (Excel, Word, Outlook, and Teams).
- Ability to manage multiple tasks and prioritize effectively.
- Exceptional attention to detail and organizational abilities.
- Ability to support EST hours.
- Experience with Xifin is a plus.
Responsibilities
- Review and analyze denied claims to determine the basis for denial and assess appeal potential.
- Communicate with healthcare providers and insurance representatives to gather necessary documentation for appeals.
- Ensure all payor required documentation is submitted with each appeal and tracked in the billing system.
- Monitor and follow up on submitted appeals to ensure timely resolution.
- Apply healthcare regulations, payor policies, and coding guidelines to maintain compliance in the appeals process.
- Identify and analyze denial trends, recommending process improvements to reduce future denials.
- Research payor-specific appeal processes to ensure proper steps are followed.
- Collaborate with clinical teams, market access and insurances representatives to resolve appeals issues.
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