Appeals Specialist II

Company: Community Health Systems
Location: Sarasota
Posted on: April 9, 2021

Job Description:

The Appeal Specialist II is responsible for managing and coordinating the workflow for the Appeal Team. This individual manages denial/appeal correspondence, assures accounts are assigned to the appropriate nurse for appeal review, and performs timely follow-up for appeal determinations. This individual also is responsible for accurately entering data into the appeal log. Quality work is imperative for the department to run efficiently.

• Manages workflow for all incoming denial/appeal letters & audit correspondence via centralized email and isynergy folders.
• Accurately vets accounts; meets or exceeds quality & quantity benchmark targets as established (productivity/PDFU)
• Directs ClaimIQ/Artiva requests to appropriate parties for appeal review & validation.
• Completes ClaimIQ/Artiva requests within 72hours and documents appropriately
• Manages PDFU to assure timely follow-up of accounts to effectively move through the revenue cycle.
• Accurately enters data into logs, DAR/Artiva, or other programs.
• Submits requests for medical records, ub's, and itemized bills as needed.
• Coordinates external audit activity and appeal vendor activity
• Provide clerical assistance to the Denial Management Team by assisting with correspondence, appeal letters, maintaining software libraries and mailing and tracking their receipt.
• Post 986 adjustments for commercial accounts, as requested by Sr. Director
• Ability to perform all other duties as assigned or requested. This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources. CHS---and Community Health Systems are tradenames/trademarks of Community Health Systems Professional Services Corporation, which provides management services to affiliates of Community Health Systems, Inc. The terms "Community Health Systems," "CHS," the "Company," or the "organization" refer to Community Health Systems, Inc. and its affiliates including Community Health Systems Professional Services Corporation, unless otherwise stated or indicated by context. The term "facilities" refers to entities owned or operated by subsidiaries or affiliates of Community Health Systems, Inc. References herein to "employees" or to "our employees" or "we" refers to employees of affiliates of CHS Inc.

Keywords: Community Health Systems, Sarasota , Appeals Specialist II, Other , Sarasota, Florida