• Follow-up with insurance carriers on underpaid claims by phone; complete follow-up actions as advised • Research claim variances in hospital patient accounting systems (EPIC, Meditech, Cerner, Athena) • Draft appeals to insurance carriers on denied or underpaid claims • Review claim detail including coding, billing and insurance information for discrepancies • Run claims data through various pricing software

• Maintain, implement, and troubleshoot billing applications with a focus on NextGen EPM software. • Import and correct daily interface files from hospital systems and manage data entry for failed files. • Upload and process electronic claim files, insurance verification, and ERA reports. • Review and resolve failed claims within the clearinghouse, mapping payers to electronic payer numbers. • Manage outsourcing of daily self-pay encounter billing, bad debt files, and reconciliation reporting. • Retrieve payment files from credit card vendors and process reports for batching into eBridge. • Resolve or escalate tickets, ensuring clear communication with internal teams and external customers. • Support QA testing, auditing, and development of electronic billing applications. • Monitor dashboards and reporting trends, flagging issues to the Billing Applications Manager. • Act as backup to team members and manager when needed.

• Facilitate the process of client estimate disputes on submitted job files. • Logging, tracking, and ensuring completion of all disputes to ensure responses are timely and in compliance with all applicable contracted timeframes, standard of drying requirements, and company policy is enforced. • Review an estimate based on carrier guidelines • Manage efficient cycle times and quality of estimate reviews timely and in a fair manner. • Examine documents for completeness, accuracy, and conformance to carrier guidelines • Ability to understand and have a solid technical background that includes an exceptional understanding (and possible hands-on experience) in loss estimating, homeowner residential, commercial. mitigation and construction. • Comfortable working in a metrics driven claims environment. • Strong analytical and mathematical ability. • Exercise objective judgment and critical decision making to resolve issues • Note and follow up on discrepancies in files • Effectively communicate with franchises and clients via phone, email, and internal/external systems to accurately bring both parties to agreement on an invoice amount to be paid and the billing dispute closed in a timely manner. • Escalating disputes to the appropriate professional for review to obtain completion and receive Franchise payment. • Conduct thorough investigations of all information provided, by analyzing all the issues involved and obtaining responses and information from internal and external entities • Work as an effective interface/liaison between internal and external customers • Monitor daily and weekly pending reports and personal worklists, ensuring internal & contractual timeframes are met. • Identify areas of potential improvement and provide feedback and recommendations to management on issue resolution, quality improvement, policies and procedures, cost saving opportunities, best practices, and performance issues. • Back up audit team as needed • Back up customer complaints as needed • Perform other duties as assigned or required. • Regular attendance is an essential function of the job.

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.