Job Description

Your days will be filled with: 

• Managing the appeals process so that appeals are filed as required by the payer and in a timely manner.  This entails:
  • Reviewing assigned denials and EOBs for information needed for the appeal and gathering any missing information.
  • Reviewing case history, payer history, and payer/state requirements to determine appeal strategy.
  • Preparing appeal letters (citing the relevant laws, regulations, guidelines, or policies that support the reversal of the claim denial), attaching all the required documentation, and/or completing forms (as necessary) for sending (via mail, email, fax) to the payer.
  • Complying with all 1st, 2nd, 3rd, and External Level Appeal processes (as needed).
  • Entering notes in the Billing & Collection system (AMD) related to actions taken; uploading all correspondence and documentation sent/received for each appeal.
• Creating standard forms and reporting around the appeals process.  This includes:
  • Working with the Manager of Billing & Collections to create a process for the assignment of denials.
  • Creating templates to be used in the appeals process (i.e. letters to be used during the different stages of the appeal process and/or in response to typical appeal situations).
  • Creating reports to track all appeals received, assigned, and completed (tracking should include data on payer, volume, reason, etc.). Providing regular reports of trends to the Manager of Billing & Collections as well as Contracting (when needed).
• Investigate credit balances (unapplied cash).  This includes:  
  • On a weekly basis, reviewing credit balances that have been created.
  • Researching credit balances, which includes checking posting, contractuals, and remits/EOBs to determine the correct dollar amount for refund.
  • Verifying the correct refund address and completing the appropriate forms.
  • Working to clean up older credit balances.
• Perform various other tasks as assigned.

Qualifications

ARE YOU OUR NEXT TOBIIAN?

To be successful in this role and at Tobii you need to be able to work cooperatively as a member of a team. 

WE ARE LOOKING FOR SOMEONE WHO HAS:

• High School Diploma
• 3 or more years medical insurance collection, appeals, and 3rd party payer experience
• Knowledge of state, federal, and third-party payer criteria and funding regulations
• Knowledge of Durable Medical Equipment (DME) Billing and Prior Authorization preferred
• Knowledge of payment posting process regarding contractual adjustments and refunds preferred

SKILLS NEEDED TO BE SUCCESSFUL IN THIS POSITION:

• Proficient in MS-Office Word and Excel
• Able to research via the internet
•  Basic data and word processing skills
• Excellent written and verbal communication skills – must be able to create concise appeal letters
• Ability to work with other departments – includes the ability to be able to articulate the details of situations to others that may not have been involved in the situation from the beginning
• Ability to communicate at all levels within the organization
• Detail orientated
• Apply independent judgment and manage confidential information
• Time management skills
• Be able to research, interpret, and understand health insurance appeal and dispute resolution processes, applicable guidelines, and health payer coverage policies to effectively prepare appeals

WE FIND IT TO BE A STRONG MERIT IF YOU HAVE EXCELLENT ORGANIZATIONAL SKILLS. 

Additional Information

Please address your questions to Ashley Weiss, ashley.weiss@tobiidynavox.com and submit your resume through our website as soon as possible. Don't wait! At Tobii, we move quickly!

Tobii Dynavox values equality of opportunity, human dignity, and racial/ethnic and cultural diversity. Tobii Dynavox does not discriminate against individuals on the basis of race, color, sex, sexual orientation, gender identity, religion, disability, age, veteran status, ancestry, or national or ethnic origin.

Equal Opportunity Employer/AA Women/Minorities/Veterans/Disabled