Appeals Specialist II: Denials & Reimbursement(RN/PT/OT/SLP)

Community Health Systems, Inc.; Franklin (TN); Remote; USD 55.000 - 75.000; Vollzeit

Benefits dieser Stelle

Health coverage

401(k) matching

Student loan assistance

Tuition assistance

Competitive pay + benefits

Paid time off

Zusammenfassung

Community Health Systems seeks an Appeal Specialist II to review and resolve insurance denials, ensuring proper reimbursement and regulatory adherence. You will log denials for trend reporting, provide feedback to facilities, and relay payer updates to stakeholders.

This role collaborates with internal teams to drive timely appeal resolutions and supports denial prevention initiatives. The position emphasizes handling medical necessity appeals, monitoring processes, and maintaining thorough

Qualifikationen

• Basic knowledge of medical billing, coding systems, and insurance claim processes.
• Strong communication skills for interacting with insurance carriers, patient financial service units, and other departments.
• Detail-oriented, with strong organizational and time management skills to manage a high volume of appeals.
• Proficiency in using healthcare billing software and Google Suite.

Aufgaben

• Files medical necessity and appeals using guidelines (MCG, InterQual, CMS) and other needed criteria.
• Monitors and provides guidance on clinical appeal processes and trends.
• Tracks and manages clinical denials using current tools.
• Identifies patterns in denials and communicates findings to relevant stakeholders.
• Maintains documentation regarding payer resources and denial/appeal processes.
• Follows CHS Appeal Process and HIPAA requirements.
• Delivers excellent customer service to patients and stakeholders.
• Documents actions in Artiva, HMS, and other systems per standards.
• Uses policy manuals and reference materials from insurers and regulators.
• Maintains confidentiality of patient accounts.
• Performs other duties as assigned.
• Maintains regular attendance.

Kenntnisse

Medical billing knowledge

Communication skills

Attention to detail

Healthcare billing software

Google Suite

Ausbildung

Associate Degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy

Bachelor's Degree in Nursing, Physical Therapy, Occupational Therapy, or Speech Therapy

Jobbeschreibung

Community Health Systems seeks an Appeal Specialist II to review and resolve insurance denials, ensuring proper reimbursement and regulatory adherence. You will log denials for trend reporting, provide feedback to facilities, and relay payer updates to stakeholders.

This role collaborates with internal teams to drive timely appeal resolutions and supports denial prevention initiatives. The position emphasizes handling medical necessity appeals, monitoring processes, and maintaining thorough