AMR

Medical Billing / Revenue Cycle Specialist / Appeals and Denials Specialist in St Louis, MO

Requisition ID
2020-10853
Category
Accounting/Finance/Audit
Employment Type
Regular Full-Time

Job Description

The Medical Appeals and Denials Specialist is responsible for ensuring that GMR provides timely and responsive replies to requests for additional information received from Medicare Administrative Contractors (MAC) or other government payors.  This individual will generate effective appeals to carriers using well-researched logic and solid understanding of payor reimbursement policies.

 

Essential Duties and Responsibilities:

  • Track documents associated with TPE reviews in an Excel spreadsheet and forward necessary updates to billing agent for processing
  • Review documents prior to forwarding to a MAC or other government payor to ensure all information is legible and responsive to the request
  • Contact operations, hospitals or other care providers when additional documentation is needed to support the billing and appeal process
  • Assist with accessing, monitoring and retrieving documents from various MAC portals
  • Identify and respond to patterns of denials or billing practices and perform complex account investigation as needed to achieve resolution. Denials may consist of but are not limited to: duplicate claims, non-covered services, medical necessity, level of service, and responsible party payor
  • Attend Targeted Probe Education (TPE) calls and other ambulance billing specific training provided by MACs or other government payors
  • Appeal carrier denials through review of policies, contracts, medical records, etc
  • Prioritize and organize a high volume of work and meet deadlines
  • Respond to inquiries from MACs and other government agencies, via telephone, email or fax and demonstrate a high level of customer service
  • Advise management of any trends regarding insurance denials to identify problems with particular payors or coding practices
  • Recommend efficiencies to overall departmental processes
  • Complete required reports and assist with special projects as assigned
  • Work under the oversight of the Compliance Department specific to government audits and immediately notify the Compliance Department of trends related non-compliant billing practices
  • Adhere to all company policies and procedures
  • Adherence to and compliance with information systems security is everyone’s responsibility. It is the responsibility of every computer user to know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problem

Qualifications:

  • 3+ years previous hands-on medical A/R follow-up experience in a fast-paced medical billing environment
  • Experience with ambulance coding and appeals is highly desirable

Education/Licensing/Certification:

  • High School diploma
  • Certified Ambulance Coder (CAC) certified preferred
  • Nurse or EMT/Paramedic license is highly desirable

 

 Knowledge and Skills:  

 

  • Strong knowledge of, HCPCS, and ICD-10 required; Knowledge of Correct Coding Initiative; prior experience navigating payor and clearinghouse websites
  • Computer experience in Medical billing software programs
  • Involvement with Medicare, Medicaid, HMO, and PPO appeals process and results
  • Direct insurance company contacts and adjudication procedures knowledge
  • Advanced verbal and written communication skill required
  • The ability to handle a very high volume of work with speed and accuracy is essential

 

EEO Statement

Global Medical Response and its family of companies are an Equal Opportunity Employer including Veterans and Disabled

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