Revenue Cycle Specialist - Appeals

Summary

Global Medical Response provides emergency and patient relocation services through its family of medical solutions. The Revenue Cycle Specialist - Appeals performs Medicare billing and follow-up activities, including processing denials, handling appeals and fair hearings, reviewing claims, and ensuring compliance with applicable guidelines and company policies.

Responsibilities

• Prepare and submit all billings expeditiously
• Respond to phone and mail inquiries from Medicare
• Conduct all follow-up activities including handling all correspondence for appeals and fair hearings
• Process all denials to maximum benefit
• Adhere to all company policies and procedures
• Assure that customer problems are handled properly and promptly
• Process and review assigned queues on a daily basis
• Review and advise Medicare Supervisor of any and all changes in Medicare regulations or requirements and any issues related to Medicare billing
• Input claim data information on a daily basis
• Balance journals periodically
• Ensure compliance of guidelines provided by Government related agencies and Corporate policies
• Pass Quality Assurance audits with an accuracy rate of 95% or better

Skills

• Minimum of one (1) year prior office work experience
• Minimum Of One (1) Year Medical Billing Experience
• General working knowledge of PCs and/or patient accounting computer systems is required
• Computer experience and proficiency using Microsoft Office Suite (Word, Excel, etc.), Adobe, and smartsheets
• Experience With Website Navigation Is Required
• Must type a minimum of 45 wpm and use a ten-key calculator by touch is required
• Working knowledge of medical terminology and ICD-9 and 10 coding is required
• Must be able to perform duties within tight time constraints and handle large volumes of work
• Must be able to work cooperatively in a team atmosphere
• High school diploma or GED required
• Experience with ambulance coding and appeals
• Knowledge of HCPCS
• Prior work experience performing Medicare billing, follow-up, and knowledge of Medicare terminology
• Involvement with Medicare, Medicaid, HMO, and PPO appeals process
• College courses in psychology, communications, business, and/or health services

Qualifications

Must Haves

• Minimum of one (1) year prior office work experience
• Minimum Of One (1) Year Medical Billing Experience
• General working knowledge of PCs and/or patient accounting computer systems is required
• Computer experience and proficiency using Microsoft Office Suite (Word, Excel, etc.), Adobe, and smartsheets
• Experience With Website Navigation Is Required
• Must type a minimum of 45 wpm and use a ten-key calculator by touch is required
• Working knowledge of medical terminology and ICD-9 and 10 coding is required
• Must be able to perform duties within tight time constraints and handle large volumes of work
• Must be able to work cooperatively in a team atmosphere
• High school diploma or GED required

Nice to Haves

• Experience with ambulance coding and appeals
• Knowledge of HCPCS
• Prior work experience performing Medicare billing, follow-up, and knowledge of Medicare terminology
• Involvement with Medicare, Medicaid, HMO, and PPO appeals process
• College courses in psychology, communications, business, and/or health services