Medicare Appeals Specialist I
Location: Dillon, Montana
Description: KCI / LifeCell is at present looking to employ Medicare Appeals Specialist I right now, this position will be placed in Montana. For detail informations about this position opportunity please read the description below. Position Summary:
The Appeals Specialist I is responsible for 1) patient primary insurance claims denied reimbursement by a DMERC will be evaluated and processed in a timely manner in accordance with State and Federal laws, 2) patient primary insurance claims denied reimbursement by Medicare may be processed through the Review, Fair Hearing, and the Administrative Law Judge, and 3) reviewing all Medicare denials and initiates the next appeal step for Fair Hearing or ALJ Hearing process with the appropriate DMERC consistent with the requirements specified by Medicare Appeal Process outlined in the DMERC Provider Manual.
Major Responsibilities and Duties:
Respond to email in a timely manner as needed. Listen and respond to voicemail in a timely manner as needed Provide supervisor with work progress reports on a daily, weekly, monthly basis or as required Investigate and analyze patient charts by reading documents and negotiating computer-based research. To develop, for each Medicare Insurance claim denial, a reasonable patient product use detail and history; to develop and substantiate the product use evidence, and present the patient's case to Medicare in the manner required. Write a medically concise and issue focused Review, Fair Hearing, or Administrative Law Judge letter as required. Pull denied and/or partially paid patient charts in appropriate numbers in order to maintain timely completion of the Review Department filing limit caseload. Review patient chart for complete documentation needed for reconsideration of denial and/or partial denial of payment. (I.e. Number of wounds, new wound(s), re-start patient, wound improvement, billing cycle number of denied or partially denied claim.) If documentation is missing from the patients chart, print documents from Alchemy and/or FileNet Generate a Medical Manager /M8 report and a written chronological diary of the patients VAC rentals and supplies to substantiate reason for Medicare payment reconsideration. Consistently meet and maintain production level as established by management For adjust offs, using Medical Manager, for each date of service and product code, leave a note in office notes collections, complete a Request for Adjustment, form, attach a copy of the Remittance Advice and forward to your supervisor, and add to spreadsheet. Understand and implement different tactics for a review, fair hearing and administrative law judge letter. Answer all incoming inquires regarding Review or Fair Hearing cases as appropriate. Understand their role and impact they have in the departmental team; including exhibiting positive attitudes, willingness to help wherever asked, staying focused and on task to the matter at hand, and being part of the success of your team Performs other duties as assigned.
Basic Qualifications:
High School diploma or equivalent. Experience with general office applications. 6 months previous office experience Experience with MS Office applications including: Word, Excel, and Outlook
Other Qualifications :
Ability to learn quickly, good level of oral and written communication skills, excellent organizational skills, filing and keyboarding skills. Ability to follow work instructions, work independently or as part of a team, and complete all projects and tasks in required timeframes. Ability to meet all performance and attendance requirement. Ability to work in a team environment as well as independently
Preferred Qualifications :
Experience with File Net.
Information listed above is not a comprehensive list of all duties/responsibilities performed.
This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice.
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If you were eligible to this position, please give us your resume, with salary requirements and a resume to KCI / LifeCell.
Interested on this position, just click on the Apply button, you will be redirected to the official website
This position will be opened on: Mon, 30 Jul 2012 21:27:09 GMT
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