Medical Billing/ AR and Appeals Specialist

Advanced Pain Care, Inc.; Austin (TX); On-site; USD 45,000 - 65,000; Full time

Job summary

Advanced Pain Care in Austin, TX is seeking an Appeals Specialist to manage insurance denials by reviewing claims, posting payments, handling correspondence, and writing appeals to adjust payment amounts. You will attach documents, research payments, log and track appeals, and coordinate with patients and insurers while maintaining confidentiality.

Three+ years in medical billing/claims and experience with Athena EMR are required; high school diploma or GED; strong communication and attention to

Qualifications

• Education: High school diploma or GED.
• Experience: 3+ years in medical billing/claims.
• Experience with Athena EMR system.

Responsibilities

• Review denied/unpaid claims and prepare appeals.
• Attach documents to appeal letters and track progress.
• Post payments and handle patient billing questions.
• Communicate with insurance companies and manage AR reports.
• Adhere to privacy and security requirements.

Skills

Clear communication

Attention to detail

Time management

Customer service

Confidentiality

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 confidentialityKnowledge of general medical terminology, CPT, IC (Note: The assistant output ended prematurely and incomplete. It appears the answer did not finish.)