Medical Claims/appeals Specialist

Description:

- Review and analyze denied claims, payment discrepancies, and reimbursement issues to identify the root causes.

- Initiate and manage the appeals and arbitration process for denied or underpaid claims, ensuring timely and accurate submissions.

- Prepare compelling appeal letters, supporting documentation, and necessary forms to present a strong case for claim reconsideration.

- Stay up-to-date with payer policies, regulations, and industry trends related to claim appeals and arbitration.

- Maintain a comprehensive understanding of coding guidelines, medical necessity, and reimbursement methodologies to strengthen appeal arguments.

Skills:

Appeals, Claim, medical collections, Medical insurance, TDI, NSA, commercial insurance, out of network