Appeals Specialist II
Company: Community Health Systems
Posted on: April 9, 2021
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
- 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
- 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
- Submits requests for medical records, ub's, and itemized bills
- Coordinates external audit activity and appeal vendor
- 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
- 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
Keywords: Community Health Systems, Sarasota , Appeals Specialist II, Other , Sarasota, Florida
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