Job Description

Job Description

Southeastern Retina Associates is looking to hire for an Appeals and Denials Specialist in the healthcare insurance field to join their Corporate Billing Team, In Knoxville, TN.

JOB DESCRIPTION OVERVIEW : This position is responsible for reviewing all carrier denials, taking corrective action as needed, including appeals. Maintains accuracy and production to ensure remittances are being processed effectively and timely.

ESSENTIAL DUTIES AND RESPONSIBILITIES : Reviews insurance claims to identify incomplete, incorrect, or missing information that resulted in a denial and rebills claim as necessary. Reviews denials to determine appropriate action based on carrier requirements. Assembles and submits documentation to appeal disputed claims. Contacts carriers to inquire on corrected or unpaid claims and appeals. Reviews carrier provider manuals and updates. Ensures correct reimbursement rates are paid on claims based on current contracts. Reports any consistent errors found during review that affect claims from being processed correctly. Maintain working knowledge of all payer guidelines and requirements as they relate to denials and appeals.

QUALIFICATIONS:

• High school diploma or GED

• Minimum two years related experience required in physician office billing and coding denials

• Prior experience reading and interpreting Explanation of Benefits (EOB)

• Knowledge of Microsoft Office tools and insurance carrier websites

• ICD-10, CPT and HCPCS knowledge required

• Coding certification through AHIMA or AAPC preferred