Appeals Negotiator

PHI Air Medical, LLC; Phoenix (AZ); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Sign-on bonus up to $7,500

Job summary

PHI Health is seeking an Appeals Negotiator to maximize reimbursements for underpaid payers and manage payer relationships. The role requires documenting underpayments, providing supporting documentation for additional payments, and resolving denials with strong regulatory knowledge.

The candidate should have 5+ years in medical billing/collections, experience with Medicare/Managed Care, and exceptional written and verbal communication.

Qualifications

• High School diploma or GED required.
• Bachelor’s degree preferred with 5 years related work experience.
• 5+ years’ experience in medical billing, surgical billing, billing in EMS and collections preferred.
• Medicare, Managed Care, Workers’ Comp. experience.
• 3-5 years of experience in appeals and negotiation background.
• Expertise in billing software and Internet-based research required.
• Solid knowledge of patient account systems and revenue management processes.
• Ability to work independently with strong interpersonal skills.
• Ability to draft professional appeal letters and communicate clearly.
• Understanding of regulatory documents and compliance.

Responsibilities

• Ensure the highest reimbursement for underpaid payers and maintain payer relationships.
• Identify, document, and assist in collecting underpayments from payers.
• Provide thorough supporting documentation for additional payments.
• Oversee and resolve denials requiring written response, including medical necessity and usual payments.
• Comply with federal and state regulations and clinical record information extraction.
• Report to leadership of Patient Financial Services.

Skills

Interpersonal skills

Strong written communication

Regulatory knowledge

Attention to detail

Negotiation experience

Analytical reasoning

Independent work

Education

High school diploma or GED

Bachelor’s degree preferred

Tools

Billing software

Internet research

Patient accounting systems

Job description

Appeals Negotiator

Sign on Bonus up to $7,500!

Join Our Life-Saving Team!

Are you ready to elevate your career to new heights? PHI Health is looking for dynamic, driven individuals to join our team. We are committed to providing top-tier emergency medical services with unmatched speed and efficiency, saving lives when every second counts. By supporting our mission from the ground, you will play a crucial role in orchestrating the seamless operations that keep our advanced fleet soaring and our patients safe.

With PHI Health you’ll collaborate with the best minds in the industry, driving initiatives that enhance our services and expand our reach to those who need it most. If you’re passionate about making a difference and thrive on challenges, PHI Health offers an extraordinary opportunity to impact lives and develop your professional career in a meaningful way.

Who We Are:

PHI Health is the leading air ambulance provider in the United States. With an unmatched safety record and the best aviation, medical and communication specialists in the field, we set the standard in the air medical industry. We transport more than 22,000 patients each year from our more than 80 bases across the country, all while offering services and outreach education to local communities and leading healthcare systems. Our mission is simple: move communities to health while maintaining the highest standard of safety, period.

Job Summary:

The appeals negotiator is responsible for ensuring the highest reimbursement for all underpaid contractual and non-contractual payers. The negotiator will build and maintain outstanding relationships with all payers while adhering to PHI reimbursement policies. Thenegotiator will identify, document, and assist in the collections of all contracted and non-contracted underpayments from the payers. The negotiator will provide and produce thorough supporting documentation regarding additional payment for the level of services that were rendered. This position provides oversight and resolution for claim denials that require written response. This includes denials for medical necessity, low “usual and customary” payments, not to the closest facility, and reduction to ground level payments. This position requires a high level of knowledge in compliance, federal and state regulations, and clinical record information extraction. This position reports to the leadership of Patient Financial Services.

Compensation and Benefits

• We offer a range of competitive pay and benefits package to keep our teams happy, healthy, and invested.

Schedule/Location

• 5 & 2
• Phoenix, AZ

The Successful Candidate Will Have:

• High School diploma or GED required.
• Bachelor’s degree preferred with 5 years related work experience.
• 5+ years’ experience in medical billing, surgical billing, billingin emergency medical services and collections preferred.
• Medicare, Managed Care, Workers’ Comp. experience.
• 3-5 years of experience in appeals and negotiation background.
• Expertise in billing software and Internet-based research required.
• Must have solid knowledge of patient account systems, revenue management processes, workflow systems and the ability to troubleshoot and suggest improvements.
• Ability to work independently with strong interpersonal skills to effectively interact with all levels of employees both with the client andwith PFS.
• Must have demonstrated experience in researching statutes andunderstanding regulatory documents.
• Must demonstrate the ability to draft a professional and effective appeal letter.
• Ability to verbally communicate details and understand parametersof job responsibilities.
• Ability to provide written communication using best business practices when composing letters, memorandums, and e-mails regardless of if the communication is inside the Company or with customers, clients, orproviders.
• Ability to read, write and follow specific instructions in bothwritten and verbal form.
• Requires an in-depth understanding of compliance, regulatory oversight bodies and payer requirements.
• Team player, interfaces well with employees.
• Represents the company in a positive, customer friendly attitude to other employees, clients, agencies, entities and patients.
• May have supervisory responsibility.
• This position is designated SafetySensitive for purposes of the Arizona Medical Marijuana Act.

Our Core Competencies:

• Safe. We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.
• Efficient. We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity andachieve sustainable profitabilityas a high performing organization.
• Quality. We are committed to ensuringexcellent organizational performance which producessustainable and reliable outcomes.
• Service. We are dedicated to the service of our customers, our communities and each other.

The PHI Health Advantage

For more than 40 years, our company has been providing critical air medical transport services across the country. As an organization, weoutfit each aircraft we fly with the most advanced technology,subject our crews to the most rigorous protocols and trainingand pioneer the most-forward thinking safety program in the country.

Everything that we do comes back to the safety of our crew and our patients.Our accident rate is well below the national average and we were the first to receive the Vision Zero Aviation Safety Award.This belief has guided us towards a number of industry firsts and has given us the highest safety rating in the industry.

Sign on bonus up to $7,500

DISCLAIMER

The above Statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed, as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.

PHI, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws