Medicare Payer Audit & Appeal Specialist II

Hollister Incorporated; Richardson (TX); On-site; USD 28,000 - 32,000; Full time

Benefits offered by this job

Competitive pay

Paid time off

Health and life insurance

401(k) retirement savings

Parental leaves

Job summary

ABC Medical in South Pittsburg, TN is seeking a Payer Audit and Appeal Specialist to manage daily requests for medical documents and appeals for Medicare, Humana Medicare, and Commercial payer claims related to evidence of medical necessity.

The role requires 3-5 years of Medicare experience, detail-oriented communication, and collaboration with the Referral Management team. Competitive benefits and a strong total rewards package are provided.

Qualifications

• 3-5 years of DMEPOS Medicare experience
• Experience with Brightree billing software
• Proficiency with Microsoft Office including Excel
• Bachelor's Degree preferred

Responsibilities

• Respond to payer audits and ensure timely submission
• Gather and submit required documentation through the appeals process
• Conduct follow up on audit submissions to ensure timely outcomes
• Identify denial reasons and request needed documents for appeals
• Collaborate with Referral Management to obtain supporting records
• Stay updated on Medicare LCD changes and other insurances
• Provide feedback and assist with trend analysis for process improvements

Skills

Analytical skills

Communication skills

Attention to detail

Medicare experience

Education

High School Diploma

Bachelor's Degree

Tools

Brightree

Microsoft Excel

Job description

ABC Medical in South Pittsburg, TN is seeking a Payer Audit and Appeal Specialist to manage daily requests for medical documents and appeals for Medicare, Humana Medicare, and Commercial payer claims related to evidence of medical necessity.

The role requires 3-5 years of Medicare experience, detail-oriented communication, and collaboration with the Referral Management team. Competitive benefits and a strong total rewards package are provided.