Quadax

Title: Appeals Specialist Location: Middleburg Heights, Ohio, 44130, United States Department: Medical Billing Job Description: Overview: Respond to all assigned levels of denials by submitting appeal letters and required documentation to insurance companies within the appeal filing time limits. Submit external review requests and required documentation to the state within the filing time limits. Act as a patient advocate by identifying the path needed to obtain the maximum reimbursement under the insurance plan and work with the patient to get the denial overturned. Remote: Although this position is listed as remote, the training period requires you working onsite 5 days/week for 3 months at our Middleburg Heights, OH or Milan, OH facilities before transitioning to remote. Responsibilities: - Review assigned denials and EOB’s for appeal filing information. Gather any missing information. - Review case history, payer history, and state requirements to determine appeal strategy. - Obtain patient and/or physician consent and medical records when required by the insurance plan or state. - Gather and fill out all special appeal or review forms. - Create appeal letters, attach the materials referenced in the letter, and mail them. - Coordinate phone hearings with the insurance company, patient, and physician. - Comply with all 1st, 2nd, 3rd, and External Level Appeal process, system, and documentation SOP’s. - Meet appeal filing deadlines by completing assigned worklist tasks in a timely matter and/or reporting to management when assistance is needed to complete the tasks. - Report all insurance company or state requirements and denial trend changes to the Team Leader and Reimbursement Manager. - Participate in team and appeal meetings by sharing the details of cases worked. - Act as a backup on answering incoming telephone calls as needed. - May undertake special projects assigned by the Team Leader or Reimbursement Manager. - Ability to meet predetermined Productivity Goals based on the level of Appeal. - Ability to meet Quality Standard in place (90% or greater). - Other duties as assigned. Qualifications: - High School diploma or GED - Minimum of four years health insurance billing experience - Knowledge of managed care industry including payer structures, administrative rules, and government payers - Proficient in all aspects of reimbursement - Ability to maintain confidentiality - Detail oriented - Possess excellent written and verbal communication skills - Able to establish priorities, work independently, and proceed with objectives without supervision. - Proficient in using Microsoft Excel and Word Hourly Rate $19 to $21 an hour.

• Work as needed in all appeal worklists, potentially with a focus on contracted or sensitive insurance companies. • Communicate denial and appeal trends to client engagement and payer relations teams. • Serve as an SME (subject matter expert) in insurance appeals matters and work with management to relay updates to clients. • Obtain patient consent and medical records for appeal when required by the insurance plan. • Gather updated appeal or review forms to add to form library. • Create appeal letters, attach the materials per client SOP, and submit via portal/fax/mail. • Comply with all appeal process documentation and SOPs. • Participate in team meetings, sharing case details. • Provide the best practices for other team members. • Train new or less experienced appeals team members. • Undertake special projects assigned by Production Management or client. • Review denials and EOBs for appeal filing information, gathering any missing details. • Inform management of incorrect or missing appeal default information. • Fill out special appeal or review forms. • Initiate payer projects, complete as assigned, including creating and maintaining tracking spreadsheets. • Ability to work on additional work lists as needed. • Work directly with global teams to demonstrate processes. • Once in the role, work to obtain Lean Six Sigma (LSS) Yellow Belt or higher. • Meet or exceed productivity and quality KPI goals. • Perform other duties as assigned.

Title: Manager, Production Appeals Location: Middleburg Heights, Ohio, 44130, United States Hybrid Full-time Department: Management Job Description: This position is in office in Middleburg Heights, Ohio or Milan, Ohio and is 5 days a week for the first 3 months (training period). Then reverts to hybrid model of 3 days in office and 2 days working remote each week. Role Overview: The Production Manager is responsible for leading daily production operations across domestic and global teams to ensure corporate and client performance objectives are met. This role is accountable for achieving key performance indicators (KPIs), driving operational efficiency, managing staff performance, and leading process improvement initiatives. The Production Manager ensures high-quality outputs, proactive communication, and continuous team development in a fast-paced production environment. Key Responsibilities: Performance & KPI Management: - Own and drive performance against established KPI metrics - Proactively identify and communicate risks to performance, including root cause and required support - Develop and execute action plans to address performance gaps Operations Management: - Oversee daily production operations for both domestic and global teams - Ensure work is assigned and prioritized appropriately - Monitor workflow using work management tools to identify out-of-target items - Address quality exceptions and ensure proper audit processes are followed - Identify and investigate timecard discrepancies Staff Leadership & Development: - Lead, coach, and develop supervisors and staff - Ensure supervisors are actively managing employee performance and development - Support recruitment, interviewing, and onboarding of staff and supervisors - Oversee onboarding and training programs using standardized templates and processes - Monitor staff productivity and quality KPIs and ensure coaching/training is provided - Implement corrective actions, including CPP Watch and additional support if needed - Conduct annual performance reviews and maintain documentation Global Operations Oversight: - Partner with supervisors to effectively manage global teams - Monitor query trends and escalate training needs Process Improvement: - Analyze workflows and identify opportunities for efficiency gains - Conduct regular SOP reviews to ensure accuracy and standardization - Ensure all process changes follow formal approval protocols Communication & Reporting: - Maintain professional,proactive, and timely communication with clients, leadership, and staff - Support Sr. Manager with client status reporting, , special projects, KPI reporting, and executive presentations Other duties as assigned Education/Experience: - Bachelor’s degree or equivalent work experience required - Minimum of 5–7 years of production, operations, or revenue cycle management experience - Strongly preferred: experience in healthcare operations, medical billing, or revenue cycle management, with a focus on appeals, denials management, and/or payer guidelines and processes - Demonstrated experience managing teams of 10+ direct reports in a high-volume, metrics-driven environment - Experience managing both domestic and global teams preferred - Strong leadership and team development skills - Ability to work effectively in collaboration with diverse groups of people - Positive experience in attracting, developing, coaching, and retaining high performance team members - Ability to establish priorities, effectively communicate initiatives and objectivesto staff, and drive accountability of supervisor responsibilities - Demonstrated strong integrity, positive attitude, and goal-oriented initiative - Proficiency with Microsoft Office and collaboration tools (Teams, OneNote, Planner) - Ability to maintain confidentiality and uphold PHI requirements Requirements: Physical Demands: General office demands include sitting and/or standing for extended periods of time. Dexterity with general office equipment including keyboard and mouse. Ability to lift to 25 pounds. Ability to handle stress in a fast-paced environment with multiple priorities and deadlines while adapting to a changing atmosphere. The employee will be expected to make judgement decisions, grasp new ideas, and communicate with various employees and clients at all levels.

• Follow up on claim status via insurance portals or calls to payers to determine adjudication and details. • Call payers and patients as needed to resolve claim rejections, challenge processing decisions, and verify insurance coverage. • Verify patient insurance eligibility and coordination of benefits. • Review and analyze payer correspondence. • Investigate electronic claim rejections. • Submit claims for processing corrections, to secondary insurances, or to updated addresses. • Research requests for insurance payment retractions. • Monitor and notify management of payer trends and/or claim processing issues. • Meet or exceed productivity and quality KPI goals. • Perform other duties as assigned.

• Review case history to ensure all means to obtain reimbursement from the insurance company have been completed and verify it is appropriate to move forward with the patient billing process. • Notify the client via email alert or work list that one of their patients is entering the patient billing process. • Answer questions from the client regarding a patient’s case history. • Call patients for updated insurance information. • Call the patients to offer them financial assistance and payment plans. • Review/approve statement balance. • Send letters and billing statements to the patients. • Send financial assistance applications to patients and process returned financial assistance documents. • Comply with all Patient Billing process, system, and documentation SOPs (Standard Operating Procedure). • Meet patient billing process time standards by completing assigned worklist tasks in a timely manner and/or reporting to management when assistance is needed to complete the tasks. • Participate in team meetings by sharing the details of cases worked. • Act as backup on answering incoming telephone calls as needed. • Other duties as assigned.

Oversee client data interfaces and coordinate integration implementations, while analyzing interface-related issues and participating in client meetings to support enhancements and project prioritization. Communicate effectively with clients and...

• Initiate cold lead activities to generate interest in the Quadax product set and determine whether prospects meet our lead criteria. • Penetrate new accounts at the Director and C-suite level of a respective market to close new business in support of RCM sales revenue targets. • Lead and participate in initial sales calls, proposal development, sales presentations, and final contract negotiations. • Properly document required information and coordinate next steps with internal Quadax team(s). • Utilize a strong consultative approach in selling solutions by listening, understanding and mapping the right Quadax solution set to each prospective client's unique needs. • Perform various tasks in a timely manner within company’s CRM software to effectively track next steps and document all activities and information associated with each prospect. • Collaborate with marketing to maximize our lead generation and nurturing activity to increase coverage of Quadax's RCM solutions to a national footprint in predefined market categories. • Establishing and expanding our brand throughout the Healthcare industry in your territory; positioning yourself as a trusted partner and advisor to your clients. • Coordinate on-site and remote meetings, including setup of conference calls and web presentations, demos, travel, and other activities as needed. • Assist with compiling draft responses to RFPs (Request for Proposals), RFI (Request for Information) and proposal generation during the sales process. • Capture, document, provide input to RCM sales challenges, and provide feedback regarding market dynamics and competitive intelligence as directed. • Other duties as assigned.

• Assist clients with setup, some implementation, and daily operations of the Quadax electronic claims processing software called Xpeditor. • Must be ready and able to train staff (current and new) on product features as well as everyday use. • Read multiple reports and try to identify billing trends for clients. • Present clients with additional products and features. • Contact different insurance payers while researching reasons why medical claims did not pay or pass edits. • Assist clients in writing custom data converts and test these upon implementation. • Other duties as assigned.

• Act as a conduit between clients, who bill medical insurance claims electronically, and Quadax. • Assist clients with setup, some implementation, and daily operations of the Quadax electronic claims processing software called Xpeditor. • Must be ready and able to train staff (current and new) on product features as well as everyday use. • Read multiple reports and try to identify billing trends for clients. • Present clients with additional products and features. • Contact different insurance payers while researching reasons why medical claims did not pay or pass edits. • Assist clients in writing custom data converts and test these upon implementation. • Other duties as assigned.

Provide technical leadership in designing and developing new products, evaluate emerging technologies, analyze requirements for user stories, and mentor team members to enhance their skills and knowledge.