Quadax is an information technology and services company that is headquartered in Cleveland, Ohio. Since 1973, the company has been delivering solutions and sof
Senior Appeals Specialist
Location
Ohio
Posted
2 days ago
Salary
0
Seniority
Senior
Job Description
Senior Appeals Specialist
Quadax
• 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.
Job Requirements
- High School diploma or GED
- Minimum of four years’ health insurance billing experience, or equivalent degree
- Minimum of one-year Quadax production experience
- Proficient with PAS and HARP systems
- Excellent written and verbal communication skills
- Knowledge of managed care industry including payer structures, administrative rules, and government payers
- Proficient in all aspects of reimbursement
- Able to work independently and prioritize tasks
- Ability to maintain confidentiality
- High attention to detail
- Possess excellent written and verbal communication skills
- Able to establish priorities, work independently, and proceed with objectives without supervision
- Proficient computer skills with knowledge of Microsoft Excel and Word
Benefits
- Equal Opportunity Employer
- Professional development opportunities
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