Appeals Specialist (Medical Billing)- Hybrid Schedule Position Available In Mecklenburg, North Carolina

Appeals Specialist (Medical Billing)- Hybrid Schedule OrthoCarolina – 3.5

Charlotte, NC Job Details Full-time Estimated:

$33.4K – $49.6K a year 15 hours ago Benefits Paid holidays Tuition reimbursement Qualifications Accounts receivable Medicare Mid-level High school diploma or

GED ICD-10 CPT

coding Organizational skills Trade school 1 year Full Job Description The Appeals Specialist will be responsible for reviewing all surgical and office charges that denied for bundling and coding-related issues. Submits appeals for all surgical denials based on bundling, global, and not medically necessary. Responsible for timely follow up on all appeal submissions. Coordinates with the coding department on complex surgical bundling denials. Knowledge of all insurance payer guidelines applicable to appeal submission. Primarily responsible for articulating written appeals that will lead to the denial being overturned. Creates appeal form letters for unlisted codes and maintains unlisted letter library. Provides narrative of denials/appeals at provider request. Works closely with all members of the business office, coders, cashiers, and office managers to ensure proper understanding of coding polices and protocols. Other duties and responsibilities as indicated by management. At OrthoCarolina, our team is our greatest asset and the foundation of our success. We are a diverse group of individuals, accountable to each other to uphold the standards of excellence and promote an environment of teamwork throughout the organization. OrthoCarolina has 43 unique care locations with over 1300 professionals who share a common goal to make lives better. Our employees are eligible for a full spectrum of benefits including paid company holidays, wellness programs, and tuition reimbursement. To learn more about Team OC please visit https://www.orthocarolina.com/about-us We are currently searching for an Appeals Specialist (Medical Billing) to join our Revenue Cycle team in the OrthoCarolina Business Office in Charlotte. This position is a hybrid schedule with rotating days in the office depending on department needs. The role of Appeals Specialist with our team, will be responsible for reviewing all surgical and office charges that are denied for bundling and coding-related issues. This position submits appeals for all surgical denials based on bundling, global, and not medically necessary and follows up timely on all appeal submissions. The Appeals Specialist coordinates with the coding department on complex surgical bundling denials and provides narrative of denials/appeals at provider request. This position works closely with all members of the business office, coders, cashiers, and office managers to ensure proper understanding of coding polices and protocols

Essential Functions:

Reviews need for appeal and begins appeal process to capture maximum reimbursement according to contract, government and/or third party payer guidelines. Ongoing follow up is expected for all appeal submission. Provides accurate answers to physician’s coding and/or billing questions in a timely manner. Assures that all services documented in the patient’s record are properly coded with the appropriate

CPT, ICD-10 CM

codes, place of service, correct provider, etc. When services are not documented appropriately, seeks to attain proper documentation in a timely matter or alert the appropriate staff member(s). Identifies and alerts management of denial trends and makes recommendations for front end edits and auto fixes and creates new reimbursement strategies. Provides feedback from payer bulletin and/or payer alerts regarding policies. Remains up-to-date on billing protocols, pricing methodologies, proper utilization of global edits, Medicare LCDs, and the CCI. Remains current with federal legislative changes that effect coding and reimbursement. Reviews, modifies and recommends changes to policies and procedures to improve coding and reimbursement efficiencies.

Qualifications:

High school graduate or GED. One-year certificate from college or technical school preferred. Three years of accounts receivable experience, preferred One year of experience in a health care organization. Working knowledge of ICD 10 required. American Academy of Professional Coders Certification required within one year of employment, upon start preferred. Employee Type Regular Qualifications Skills Claims Processing, Health Care, ICD-10 Procedure Coding System, ICD Coding, Insurance Claims Processing, Medicare, Medicare Operations, Reimbursement Education Certifications Language Work Experience