Medical Billing & Appeals Specialist - Denials & AR

Advanced Pain Care, Inc.; Alpiarça; On-site; EUR 32,000 - 46,000; Full time

Job summary

Advanced Pain Care is seeking an Appeals Specialist to manage insurance denials, review claims, post payments, and write appeals to correct payment amounts or non-payments. The role supports the Billing Department and requires experience with medical billing and Athena EMR.

The position emphasizes accurate documentation, timely correspondence with insurers, and strong customer service to patients. A high school diploma or GED and 3+ years of related experience are expected.

Qualifications

• Education: High school diploma or GED.
• Experience: 3+ years in medical billing/claims.
• Athena EMR experience required.
• Knowledge of CPT/ICD terminology.
• Strong communication and attention to detail.

Responsibilities

• Review and appeal unpaid/denied claims.
• Attach documents to appeal letters.
• Research insurance payments and correspondence for accuracy.
• Log appeals and grievances; track claim progress.
• Notate trends in insurance denials; generate reports.
• Contact insurance companies regarding claims/payments.
• Manage AR reports for Billing Department.
• Submit and correct claims in EMR (Athena).
• Post patient and insurance payments.
• Send paper claims to carriers.
• Answer patient billing questions.
• Coordinate payments with patients/third-party payers.
• Handle collections on unpaid accounts.
• Resolve patient billing complaints.
• Answer Billing Department calls promptly.
• Process credit card payments by phone and in person.
• Adhere to policies and professional standards.
• Support practice reputation by handling new requests and adding value.

Skills

Clear communication

Attention to detail

Phone skills

Patient confidentiality

Medical terminology

Education

High school diploma or GED

Tools

Athena EMR

Job description

Description

Job purpose

• The Appeals Specialist is responsible for managing insurance denials by reviewing claims and clinical documentation, posting payments, handling correspondence letters and writing appeals to correct payment amount and/or non-payment.

Duties and responsibilities

• Reviews and appeal unpaid and denied claims
• Attaches appropriate documents to appeal letters
• Researches and evaluates insurance payments and correspondence for accuracy
• Logs appeals and grievances, and tracks progress of claims
• Keeps up-to-date reports and notates any trends pertaining to insurance denials
• Calls insurance companies to inquire about claims, refund requests and payments
• Manages Accounts Receivable reports for the Billing Department
• Utilizes EMR system to submit and correct claims
• Posts patient and insurance payments
• Sends paper claims to insurance carriers
• Answers patient billing questions
• Coordinates medical and billing records payments with patients and/or third-party payers
• Handles collections on unpaid accounts
• Identifies and resolves patient billing complaints
• Answers phone calls to the Billing Department in a timely and professional manner
• Processes credit card payments over the phone and in person
• Serves and protects the practice by adhering to professional standards, policies and procedures, federal, state, and local requirements
• Enhances practice reputation by accepting ownership for accomplishing new and different requests; exploring opportunities to add value to job accomplishments
• Operates standard office equipment (e.g. copier, personal computer, fax, etc.).
• Has regular and predictable attendance
• Adheres to Advanced Pain Care’s Policies and procedures
• Performs other duties as assigned

Requirements

Qualifications

Education: Requires a high school diploma or GED

Experience:

Three or more years related work experience with medical billing/ claims

Previous use of Athena required

Knowledge, Skills and Abilities:

• Clear and precise communication
• Ability to pay close attention to detail
• Effectively manages day by organizing and prioritizing
• Possesses excellent phone and customer service skills and abilities
• Protects patient information and maintains confidentiality
• Knowledge of general medical terminology, CPT, ICD-9 and ICD-10 coding
• Familiarity with analyzing electronic remittance advice and electronic fund transfers
• Experience interpreting zero pays and insurance denials
• Competence in answering patient questions and concerns about billing statements
• Organizational skills and ability to identify, analyze and solve problems
• Works well independently as well as with a team
• Strong written and verbal communication skills
• Interpersonal/human relations skills

Working conditions

Environmental Conditions: Medical Office environment

Physical Conditions:

• Must be able to work as scheduled – typically from 8:00 – 5:00 M-F
• Must be able to sit and/or stand for prolonged periods of time
• Must be able to bend, stoop and stretch
• Must be able to lift and move boxes and other items weighing up to 30 pounds.
• Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.