Summary
Location
Richmond
Type
full-time
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About this role
Responsibilities
The Appeals Specialist will manage the organization’s third party payer appeals through the ability to analyze, research and successfully appeal third party claims within timely filing timelines. This position will develop payer and cross-functional hospital relationships to effectively appeal and obtain full contractual payment on claims. The Appeals Specialist will lead the organization’s denials management process and make recommendations for continuous improvement, including root cause analysis and implementation of processes to consistently reduce denials.
The Appeals Specialist will work closely with the Business Office Director and IT to build and refine the payer variance and denial reports to insure the accuracy and effectiveness of the reports. The Appeals Specialist will provide constructive feedback and suggestions to the Accounts Receivable, Patient Registration, Insurance Verification and Case Management teams in order to prevent claim denials.
Qualifications
MINIMUM EDUCATION
High School Graduate or GED Equivalent required; relevant experience in lieu of High School Diploma/GED education will be considered. Associate’s or Bachelor’s Degree in a Business related field highly preferred. Foreign Medical Graduates welcome.
MINIMUM WORK EXPERIENCE
Three to five years of job related experience.
REQUIRED LICENSES/CERTIFICATIONS
None.
REQUIRED SKILLS, KNOWLEDGE, AND ABILITIES
Must be computer literate; possess good verbal and written communication skills, and excellent analytical skills.
ABOUT OAKBEND
OakBend Medical Center is an independent hospital providing exceptional and compassionate care to patients and the community since 1950. The OakBend family consists of outstanding team members caring for the community at three hospitals and many specialty centers. OakBend’s services and programs include its signature No Wait ER, an advanced trauma center, certified stroke program, hospital air ambulance services and a hospital-based skilled nursing facility. We remain committed to providing a rewarding environment to our team members, to providing necessary services to the community and to developing the best methods to care for our patients, ensuring a healthy future for generations.
Other facts
About OakBend Medical Center
OakBend Medical Center is the last remaining independent, nonprofit hospital in the Greater Houston area, providing exceptional service with its three hospitals and many specialty centers. OakBend follows an innovative model of care that makes the patient the captain of the care team, up-ending the traditional approach to nursing where the doctors and nurses act as leaders of the team. This patient-centered care drives OakBend’s services and programs, including its signature No Wait ER, an advanced trauma center and the Jack and Billie Wendt Acute Care for the Elderly (ACE) unit.
We remain committed to developing the very best ways to care for our patients, ensuring a healthy future for generations to come.
For more information, please visit www.oakbendmedcenter.org. Connect with us on Facebook, Instagram, Linkedin, and X.
What you'll do
- The Appeals Specialist will manage third party payer appeals and develop relationships to effectively appeal claims. They will also lead the denials management process and recommend improvements to reduce denials.
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