Responsibilities
- Distinguishes clinical from technical denials by analyzing EOBs, payer correspondence, and data patterns.
- Locates and identifies relevant managed care contracts for payers and healthcare facilities.
- Examines managed care agreements to verify correct application of rates, terms, and conditions.
- Assesses timely filing rules as they relate to the appeals process.
- Communicates with payers to resolve technical denials through negotiation.
- Submits appeals using comprehensive methods including appeal letters, medical records, supporting documents, and clinical input.
- Analyzes outcomes of appeals to determine subsequent actions, such as recording recovered funds, validating upheld decisions, or filing secondary appeals.
- Handles assigned accounts with consistent follow-up and precise documentation.
Compensation
$20.00 hourly
Work Arrangement
Remote within US ONLY
Other
- Work location is remote, limited to the United States.
- Required to work Monday through Friday, either 7:00 AM - 4:00 PM EST or 8:00 AM - 5:00 PM EST.
- Must have sufficient eye-hand coordination and manual dexterity to operate standard office equipment.
- Capable of working at a computer terminal for 6 to 8 hours daily in an environment with frequent interruptions.
- May be required to sit for extended durations.
- Occasionally required to lift and transport materials up to 20 pounds.
- May encounter high-stress situations during peak workloads and tight deadlines.
- Work equipment is provided.
