Follow-Up Specialist

Job/Position Title:

Follow-Up Specialist

Reports To:

Manager, Business Operations

Department:

AppealMasters

Status:

Part-Time, Temporary

Purpose:

This position is responsible for obtaining payer decisions on all appeals/retro-authorization requests filed by the Medical Appeal Advocates. 

Duties:

• Making high-volume of phone calls and utilizing payer portals to obtain decisions as efficiently as possible.
• Demonstrating a professional demeanor at all times when working with payers and clients alike.
• Demonstrating the ability to prioritize your day to meet business needs.
• Demonstrating superior organizational skills.
• Maintaining a high level of integrity and discretion when handling protected health information (PHI) per HIPPA compliance regulations.
• Processing medical reimbursements for denied commercial, government, and managed care claims as assigned.
• Processing medical records.
• Reviewing Explanation of Benefits (EOB) audit and denial letters and taking appropriate action via verbal or written appeal to challenge low payments and various denials.
• Input all Payer disputes into the Veracity (PayerWatch proprietary software) daily.
• Complete assigned tasks per departmental policies. 
• Contact payers to request needed documents and follow up on pending appeals.
• Demonstrate organizational and time management skills to manage accounts.
• Maintain a high level of integrity and confidentiality for patient privacy per HIPPA requirements.  All information (written, verbal, electronic, etc.) that the Follow-up Specialist encounters while working in a reimbursement environment is ALWAYS confidential.
• Perform other duties as assigned.

Minimum Qualifications:

Education:

High School or equivalent

Minimum Experience:

Two years of experience with Microsoft Office

Prior knowledge of the healthcare industry/health insurance companies

Preferred Qualifications:

Education:

Associate's degree in a healthcare or business field (such as healthcare or business administration). 

Preferred Experience:

Outstanding interpersonal, verbal, and written communications skills

Solid problem-solving and analysis skills that demonstrate resourcefulness and attention to detail.

Ability to work independently as well as in a team environment by collaborating with others and sharing tools, skills, and knowledge.

Demonstrated computer, prioritization, and time management skills.

Outstanding interpersonal, verbal, and written communication skills are required.

Must be flexible and able to work in a fast-paced, heavy-volume work environment.