Appeals Referee Job Description Sample
The Department of Human Resource Management, Office of Health Benefits is seeking a qualified individual to fill the position of Appeals Examiner. This position will be responsible for evaluating and coordinating clinical appeals and their review by the Programs' external independent review organizations.
The incumbent will thoroughly investigate all aspects of appeals to obtain the most complete review and equity on behalf of the appellant. This position will also coordinate the handling of administrative appeals and handles inquiries and complaints from State and Local Choice employees, retirees and their dependents. Also, this position will serve as the HIPAA Privacy Officer and will be responsible for establishing and implementing policies and procedures with respect to the privacy of protected health information (PHI) under the federal Health Insurance Portability and Accountability Act and monitoring HIPAA security standards. Additionally, this position will participate in projects and vendor compliance with other OHB staff.
Considerable knowledge of medical environment and terminology; Working knowledge of law and regulations governing the Administrative Process Act and appeals; Demonstrated ability to analyze regulations, cases and issues; Demonstrated ability to use a personal computer to produce correspondence and spreadsheets; Demonstrated ability to communicate effectively; Demonstrated ability to establish priorities, work independently, and proceed with objectives without supervision and Demonstrated customer service skills. High school graduate or equivalent. Preferred Qualification (s):
Medical claim training and experience; Experience, certification or education in health benefits highly desirable; experience in policy application and customer service.
Lynwood | Pico Rivera | Santa Fe Springs |
El Monte |La Puente | S. Whittier
Referee: Middle School
The Referee is responsible for the instruction, supervision and officiating of the following sports: Soccer. Previous officiating experience is desired, but not necessarily required The Referee will work to maintain a positive environment for everyone involved by: ensuring games start on time, keeping players safe, officiating games, interacting regularly with players, parents, volunteers and staff.
Keeps participants, coaches and parents informed at all times (scorekeepers).
Enforces Game rules and regulations.
Checks players for proper uniform and equipment.
Follows, administers and implements Think Togethers policies and guidelines.
Experience working with young children and the ability to inspire and motivate.
Ability to speak and write standard English appropriate in a public-school setting.
Must clear TB and Fingerprint check.
- MUST be available at least 3 days a week (5 preferred), Monday - Friday (3:00 -6:00pm).
Think Together is in search of outstanding individuals from all backgrounds, majors, and career interests. If you think you are ready to shape the lives of students, build relationships with families, provide students with the foundational knowledge, skills and mindset to pursue their dreams and become successful leaders, we invite you to apply.
Apps Appeals Agent - Japanese Language (Temporary Assignment)
Apps Appeals Agent
Japanese Language (Temporary Assignment)
Temporary Contractor Assigment: Apps Appeals Agent
- Japanese Language
Start Date: June 24, 2019
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ACCENTURE CONTRACTOR EXCHANGE solves clients' toughest challenges by providing unmatched services in strategy, consulting, digital, technology, operations and security. Develop and enhance your skills and experience, working across diverse teams, projects, and industries.
The Operations team has a position available within the Digital Content division. This individual is expected to build a deep understanding of Client Program policies, and provide policy support to internal and external parties. This team has a strong emphasis on customer support, as we will continually measure customer satisfaction.
Participate in day-to-day operations for Client Operations and other cross-functional teams
Perform reviews and research in order to provide excellent policy support
Attain daily productivity goals while maintaining quality standards
Refine tools and processes around daily workflow, and maintain documentation for weekly management reporting
Open to overtime as needed to assist the global team in closing out high volumes
Preferred Bachelor's Degree any field
Excellent work ethic, self-driven, team player, goal-oriented
Independent worker who can prioritize tasks and manage time effectively
Ability to multi-task and adapt to rapidly-changing environment and process
A passion for Apps / Mobile devices, and experience working with similar / related industry
Strong understanding of policy with adaptability under ambiguity
Comfortable working in situations that often contain grey areas
Excellent written and verbal communication skills, with an emphasis on English customer support
Availability for overtime when the project demands it
Not offended by Apps that might come up as R-rated or higher: violence, gore, nudity
Proficient in Japanese language (Read/Write)
Applicants for employment in the US must have work authorization that does not now or in the future require sponsorship of a visa for employment authorization in the United States and with Accenture (i.e., H1-B visa, F-1 visa (OPT), TN visa or any other non-immigrant status).
Candidates who are currently employed by a client of Accenture or an affiliated Accenture business may not be eligible for consideration.
Accenture is a Federal Contractor and an EEO and Affirmative Action Employer of Females/Minorities/Veterans/Individuals with Disabilities.
Equal Employment Opportunity
All employment decisions shall be made without regard to age, race, creed, color, religion, sex, national origin, ancestry, disability status, veteran status, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status or any other basis as protected by federal, state, or local law.
Job candidates will not be obligated to disclose sealed or expunged records of conviction or arrest as part of the hiring process.
Accenture is committed to providing veteran employment opportunities to our service men and women.
To all Agencies/Vendors: We do not accept agency resumes. We are not responsible for any fees related to unsolicited resumes.
To all Contractors: Please note this is a temporary contractor assignment. As a contractor you will not be employed by Accenture; instead, you will be employed by one of our preferred vendors. This role requires authorization to work for any employer in the respective country without visa sponsorship.
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Medical Billing / Appeals
More than a career - a chance to make a difference in people's lives!
When you have the power to make a difference in the health and well-being of others, every day is extraordinary.
Are you customer driven, returning to the working force or is this your first career?
You will thrive in a fast-paced and dynamic environment where it's all about multi-tasking to get the job done. If you are positive and professional with a focus on solving problems and doing whatever it takes to make a difference to every customer every time you are a match for CCS Medical! If you relate well to all kinds of people, explain things easily in ways that our patients can understand and listen attentively, and can hone in on the most important issues then.…….. this is the career for you!
As a Revenue Cycle Specialist, you'll be at the heart of our customer service operations as you deliver first-class customer service in every interaction in our call center. You will be responsible for claim submission and claim resolution for CCS Medical patients regarding governmental, commercial insurance companies and patient accounts. You'll be the one of our subject matter experts that will help us solve our patient's challenges-and deliver on our promise of superior customer service.
What you'll be doing...
Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
Researches and follow up on all correspondence associated with assigned accounts, including EOB's and documentation letters, and generate correspondence requesting required information, when necessary
Initiates appeals and ensures all required documentation is submitted in the appeals process. Researches all denials and follow up as necessary.
Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds
Reduces delinquent accounts and achieving maximum collections from all sources
Analyzes and correct accounts receivable problems
Posting payments and / or adjustments to individual accounts
Resolving credit balance accounts as needed
Achieves productivity goals based on accounts touched, dollars collected, and aging period
Identifies problems or improvements within own area, develops resourceful and alternative solutions for work improvement or problem solution
Maintains a high degree of confidentiality always due to access to sensitive information
Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
Follows all Medicare, Medicaid, HIPAA, and Private Insurance regulations and requirements
What WE Bring to the Table:
We offer a wide variety of insurance benefits after 60 days of employment (medical, dental, vision, short and long-term disability and life) with a large portion of premiums paid by the company, as well as paid time off within the first year. We also offer a 401(k) plan with a generous company match and vesting schedule, financial planning, competitive salary, and an EAP-Employee Assistance Plan.
What YOU Bring to the Table:
High school diploma or GED equivalent
Minimum of two years of medical billing/collections experience necessary. Must be knowledgeable of reimbursement processes and procedures.
Ability to work with other employees
Proficient in basic PC skills (MS Office)
Organized work habits, accuracy, and proven attention to detail, with strong analytical skills
Ability to work within a team setting and as an individual contributor
Excellent oral and written communication skills
CCS Medical is an Equal Opportunity Employer /Veterans/Disabled
Appeals Letter Writer
Work From Home
Parallon believes that organizations that continuously learn and improve will thrive. That's why, after more than a decade, we remain dedicated to helping hospitals and hospital systems operate knowledgeably, intelligently, effectively and efficiently in the rapidly evolving healthcare marketplace, today and in the future. As one of the healthcare industry's leading providers of business and operational services, Parallon is uniquely equipped to provide a broad spectrum of customized revenue cycle services.
Are you an excellent technical writer, able to craft written business communication to effectively collect funds from third-party providers? Do you excel in proper document formatting, and take pride in developing quality business letters?
Parallon's Appeals team is currently seeking an Appeals Letter Writer who will utilize their exceptional writing skills to ensure the business receives timely payment and resolution to issues!
Whether you are per diem, part-time, or full-time, you are eligible to participate in our 401K program, with company match! Part and full-time employees gain access to incredible benefits, including health, life, dental, and pet insurance. Thinking about returning to school? We offer tuition reimbursement, and an ever popular student loan forgiveness program! Our popular employee discount program provides you with deep discounts on everyday purchases, like cell phone plans and travel. The benefits of working for Parallon are exceptional!
If you're looking for a career path in Appeals, Parallon can help you reach your goals. We believe in promoting from within, and individuals hired as an Appeals Letter Writer can continue up the ladder, based on performance, to Team Lead and Management as their skills and competencies expand. The position a full-time, work from home opportunity. Parallon provides all equipment to perform the job, and pays a monthly stipend for internet access.
As our next Appeals Letter Writer, you'll have the following duties and responsibilities:
Triage incoming inventory for the Appeals team, validating appeal criteria is met
Compose technical denial arguments for reconsideration, including both written and telephonically
Identify contract protection that can be leveraged to overturn denials
Pursue additional payment on open appeals through various means of communication, such as telephonically, online or via payment package processes with payers and patients.
Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument
Identify problem accounts/processes/trends and escalate as appropriate
Escalate accounts to appropriate individuals at the payer and via SSC management as needed, including accounts with lack of timely payer response
Communicate trends to management as identified
Utilize effective documentation standards that support a strong historical record of actions taken on the account.
Able to perform basic mathematical calculations, balance and reconcile figures.
Meet the productivity and quality standards of the organization
- High school diploma or GED required.
Excellent use of grammar, document formatting, and business letter writing.
One year experience with Word, Adobe, Excel, and Outlook.
One year experience with medical terminology.
One year of related experience in healthcare.
We invite you to join our team today. Apply online now!
"We are an equal opportunity employer and we value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status."
Medical Auditor & Appeals Specialist - Patient Accounting - FT - Days
Full-Time Position (80 Hours Per Pay Period)
Shift: 0800-1700 Days: Varied
Wages Based Upon Experience
CLOSING DATE: Open Until Filled
EXPECTATION FOR ALL EMPLOYEES
Support the organization's mission, vision and values by adhering to the behavioral standards of Bay Area Hospital. Comply with all laws and regulations affecting Bay Area Hospital. Be familiar with and adhere to the Code of Conduct and support the Bay Area Hospital Compliance Program. Effective communication skills and the ability to work effectively with people from various backgrounds are critical.
Audits records to ensure that documentation matches charges and reviews denials and acts as liaison with vendor on outsourced appeals.
PRINCIPLE DUTIES AND RESPONSIBILITIES
(Essential job requirements listed in bold)
Audits revenue cycle with specific focus on documentation, charge capture, medical appropriateness, regulatory compliance, billing accuracy, and compliance with hospital policy
Audits areas of concern based on direction of executive leadership and compliance committee with periodic reports
Serves as the point person for payer and/or Recovery Audit Contractors (RAC) focusing on defending hospital claims for reimbursement
Conducts regular audits and coordinates ongoing monitoring of coding and documentation accuracy and provides feedback and focused educational programs on the results to affected staff, physicians and compliance officer
Assist PFS II staff with appeals on denied claims
Reviews denials to determine when to outsource and acts as a liaison with outsourced vendors
Works with third party payers to ensure accurate payment and resolution of billing issues
Maintains RAC, CMS, TPE, and ADHOC log, database, produces reports requested and assists with appeals associated with RAC
Works with department managers on validation of documentation practices and charge capture
Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity
Serves on the compliance committee
Provides analysis of audits and written reports as assigned
Resource for revenue cycle staff
SKILLS AND ABILITIES
(Essential job requirements listed in bold)
Demonstrates the ability to use a personal computer and various software programs applicable to the position
Exhibits the ability to deal effectively interdepartmentally, with the public, vendors, and governmental agencies
Maintains regular, consistent and punctual attendance at the assigned job location
Demonstrates the ability to operate applicable office equipment
Exhibits the ability to maintain confidentiality, think and act independently with minimal supervision
(Essential job requirements listed in bold)
Registered Nurse (RN) or equivalent experience
Bachelor's Degree in Nursing (BSN) preferred
Required to have or is actively pursuing at least one of the following certifications
Certified Medical Auditor (CMAS)
Certified Coding Specialist (CCS)
Certified Professional Coder by the American Academy of Professional Coders (AAPC)
Certified Professional Healthcare Management (CPHM)
(Essential job requirements listed in bold)
5 years' experience in an acute care hospital auditing, coding, billing, or related field such as health-care administration
Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing
Experience with physician & other clinician education/feedback on documentation improvement
Experience with healthcare billing, coding and revenue cycle principles and regulations preferred
Union Affiliation: None
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities and job skills required.
Requires extensive sitting with periodic standing and walking
May be required to lift up to 20 pounds
Requires significant use of personal computer, phone and general office equipment
Needs adequate visual acuity, ability to grasp and handle objects
Needs ability to communicate effectively through reading, writing, and speaking in person or telephone
May require off-site travel
The future looks bright at Bay Area Hospital, and we are always searching for quality people to join our team. We offer a great atmosphere, competitive pay, a wide array of benefits, and many growth opportunities for our employees.
Administrative Assistant/Receptionist - WV Supreme Court Of Appeals
Nature of Work
Administrative Office of the Supreme Court of Appeals – Administrative Assistant/Receptionist: The Supreme Court of Appeals of West Virginia has an immediate professional opportunity for a Probation Office Secretary in Weston, West Virginia.
This position directly reports to the Chief Probation Officer. This position provides clerical, data entry, purchasing, and administrative assistant duties assigned by the Probation Officer and Judge. Primary duties and responsibilities include prepares email, correspondence, court orders, as well as presentence and other reports for distribution; monitor deadlines, prioritize tasks, and need for action related to probation issues; inputs data and uploads reports, Court Orders and other documents into Offender Case Management.
Proficient typing skills and professional phone etiquette is desired. Must possess the ability to manage multiple tasks. Successful candidates must submit to criminal background check. Performs other duties as assigned.
How to Apply: Interested candidates must submit the following application materials to:
Upshur County Courthouse
PO Box 737
Buckhannon, WV 26201
Completed Court Employment Application (available on Court website)
Signed, Notarized Release for Criminal/Background Check
Letter of Interest highlighting applicable experience
References (at least three with current contact information)
Agency Website: http://www.courtswv.gov
This job opportunity is not in the classified service and is not covered under the Administrative Rule of the WV Division of Personnel . Therefore, online applications are not accepted for this position. Interested persons must apply directly to the hiring agency as indicated above. Minimum Qualifications
Training: High school diploma or GED
Revenue Integrity. Appeals Coordinator
Main Line Health, with over 11,000 employees and 2000 physician practices, is suburban Philadelphia's most comprehensive health care resource, offering a full range of medical, surgical, obstetric, pediatric, psychiatric and emergency services. We are composed of five hospitals, a medical research institute, physician practices and other specialized facilities and services. Main Line Health is committed to the highest standards of patient care, education and research.
Main Line Health has achieved numerous honors and awards and has been nationally recognized by Press Ganey, Truven Analytics, The Joint Commission and other health care ratings organizations for its high quality patient care. We have received Magnet® designation by the American Nurses Credentialing Center (ANCC), the nation's highest award for recognizing excellence in nursing care. At Main Line Health, we have made it our mission to provide patients with a superior patient experience. This translates to the consistent delivery of safe, high quality clinical care in the absence of preventable harm.
Why Work for Main Line Health?
We are committed to providing exceptional care with empathy and compassion for people at all stages in life. Our Diversity, Respect and Inclusion Initiative celebrates our differences and our similarities. Ultimately, we want everyone to feel respected for who they are. Main Line Health has consistently been ranked among the best places to work by Best Places to Work in PA and the Philadelphia Business Journal. We also rank among Modern Healthcare's top 100 places in the nation to work in health care. Our physicians and employees speak highly of the work environment at Main Line Health.
The Revenue Integrity Appeals Coordinator position supports the Revenue Integrity division with efforts to support denials, appeals, and compliance activities within the Revenue Cycle system as it relates to audits.
Requirements To Include:
The Coordinator will be responsible for managing the timely synchronized response to RAC, government, and other payer audits, for maintaining an accurate tracking database of requests, correspondence, actions, and outcomes.
The Coordinator supports policy development, implementation, and staff education.
Works with multidisciplinary team to evaluate and improve the denial management, documentation and appeal process.
Requires strong interpersonal and communication skills, well-developed analytic and organizational skills, and the ability to meet deadlines while influencing, but not directly managing the work of others.
Bachelors degree in related health care field, preferred
HS Diploma required
Licensures & Certifications:
- RHIA, CCP, CCS preferred
5-10 years of experience in coordination of audit denial and appeals
required Knowledge of CMS regulations
Commercial Billing and Medical Policy Knowledge of applications for RAC/Audit tracking and trending
Comfortable with Microsoft Office Tools Effective verbal and written communication skills required Familiar with patient accounting process
We offer competitive compensation and outstanding comprehensive benefits including tuition reimbursement, 403B matching savings plan, a pension plan, and a generous paid time off program. To be considered, please apply online with your resume at https://www.mainlinehealth.org/careers Enter Job ID 48713 in Keyword search box.
Applicants must certify that they have not used tobacco products or nicotine in any form in the 90-days prior to submitting an application to Main Line Health. This will be verified during pre-employment testing. We are an Equal Opportunity Employer. Please, no agency calls.
Claims Appeals Coord I
The Claims Appeals Coordinator I will:
Be responsible for the accurate review and processing of claim appeals/grievances, coordination of benefits and eligibility in accordance with company policies and contract guidelines.
Apply proper claim concepts, rules and practices, ensuring accuracy and timeliness of claims payment through demonstrated knowledge of medical terminology, health insurance plans and medical billing concepts.
Employ good written and oral communication skills when supplying determinations to members, providers and third parties when needed.
Have the ability to work independently as well as with a team to accomplish daily departmental goals in a production environment.
Assist with training and communicating work priorities and projects within the team.
Generate reports to track and trend productivity.
Take on other responsibilities as assigned.
This position is located in the Franklin TN office.
Minimum Experience Required
2-3 years in medical billing or claims processing
Proficient in Microsoft office products
Previous experience in Cherwell and ISAAC a +
Our Company and What We Offer
Core healthcare is committed to making a positive impact on healthcare, and also making a positive impact on our employees. evi
Core offers a variety of perks and benefits including, but not limited to:
Flexible scheduling and work/life balance with remote and work from home opportunities
3 weeks of PTO(starting) per year plus paid holidays
Education assistance, tuition reimbursement and professional certifications
Health, dental, vision, and life benefits with employer funded HSA
Comprehensive employee discount program, onsite fitness facilities, and smart casual dress code
Paid Volunteer Community Service Days
Ample opportunities for growth, advancement, and promotion
401k retirement plan with company match of 50% employee contributions up to 6%
Grievance %26 Appeals Coordinator I (Medicare)
Position Purpose: Analyze and resolve verbal and written claims and authorization appeals from providers and pursue resolution of formal grievances from members.
Gather, analyze and report verbal and written member and provider complaints, grievances and appeals
Prepare response letters for member and provider complaints, grievances and appeals
Maintain files on individual appeals and grievances
May coordinate the Grievance and Appeals Committee
Support the pay-for-performance programs, including data entry, tracking, organizing, and researching information
Assist with HEDIS production functions including data entry, calls to provider's offices, and claims research.
Manage large volumes of documents including copying, faxing and scanning incoming mail
Education/Experience: High school diploma or equivalent.
Associate's degree preferred. 2 years grievance or appeals, claims or related managed care experience. Strong oral, written, and problem solving skills.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
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