Payer Communications & Appeals Specialist

KDMC Ashland Hospital Corporation; United States; On-site; USD 32,000 - 42,000; Full time

Job summary

UK King&'s Daughters in Ashland, KY is seeking an administrative professional to support the case management department. You will handle clerical tasks, research payer requirements, and follow up on authorizations and appeals to help prevent denials.

The role involves maintaining payer portals, liaising with the business office, payers, and onsite nurses, and ensuring accurate documentation to support timely resolutions. A high school diploma and healthcare exposure are required.

Qualifications

• High school diploma or equivalent experience.
• 0-2 years of experience in a healthcare, clinical setting, or a relevant area.
• An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field.
• Part-time and PRN experience will be prorated based on hours worked per week.
• Volunteer work and internships for academic credit are not counted.

Responsibilities

• Processes incoming mail related to utilization management.
• Communicates denial information to the revenue integrity department.
• Submits appeals for technical denials and supports case managers in appeal cases.
• Researches and confirms payer requirements, educating the case management team and updating shared resources.
• Maintains all payer portals.
• Acts as a liaison for the business office, payers, and onsite nurses regarding claim issues.
• Calculates Medicare Days for patients to support authorization requests.
• Manages payroll and department schedules.
• Performs other duties as assigned.

Education

High school diploma or equivalent experience

Job description

UK King&'s Daughters in Ashland, KY is seeking an administrative professional to support the case management department. You will handle clerical tasks, research payer requirements, and follow up on authorizations and appeals to help prevent denials.

The role involves maintaining payer portals, liaising with the business office, payers, and onsite nurses, and ensuring accurate documentation to support timely resolutions. A high school diploma and healthcare exposure are required.