Laboratory Appeals Specialist

Job Description:

This position is responsible for drafting, advancing and maintaining all legal documents, letters and correspondence for appealing with third party payers to obtain reimbursement including handling difficult, hard to collect accounts that have been deemed by the insurance company to be unpayable.

Scope

This position is responsible to know all state / federal laws that relate to contract and to the appeal process and train all existing and incoming employees regarding any new laws, insurance trends and department processes / procedures.

Job Essentials

1. Conducts analysis and resolves incorrect reimbursement issues with third party payers and recognizes when the account should become involved in a payment dispute with the insurance company.
2. Conducts research and formulates a defense to support appeals with insurance companies and other payers as needed.
3. Maintains an understanding of expected reimbursement information and legal parameters pertaining to all State and Federal Laws.
4. Investigates and examines source of denials using knowledge of iCentra, ICD-10 coding and CPT coding.
5. Provides education and training to department staff concerning department processes and the correct application and interpretation of insurance law. Updates new employees and existing staff on any new laws, insurance trends and procedures / processes.
6. Maintains and updates letter database and trains department staff on appropriate use of letters.
7. Drafts, advances and maintains all legal/technical documents, letters and correspondence pertaining to all level of appeals.
8. Works closely with appeal specialists in obtaining all pertinent information required for appeal letters.



Minimum Qualifications

Bachelor's Degree obtained through an accredited institution. Education is verified.
- or -
Four years of health insurance or appeals unit experience.
- and -
Two years of experience in PAS / English Writing / Health Insurance / Public Relations or related fields.
- and -
Demonstrated extensive knowledge of the health insurance industry, health claims billing, or third party contracts.
- and -
Demonstrated excellent interpersonal skills as well as the ability to communicate effectively, both verbally and written, with staff, patients, insurance companies, and legal counsels.
- and -
Demonstrated leadership abilities.
- and -
Demonstrated detail oriented with excellent organizational skills.
- and -
Demonstrated flexible and adaptable to change.
- and -
Proficient with word processing, spreadsheet, and presentation applications, and an understanding of current on-line research methods.
- and -
Demonstrated self motivated with the ability to work without direct supervision.
- and -
Demonstrated strong analytical, fact-finding, problem solving, and organizational skills.
- and -
Demonstrated ability to clearly communicate complex issues and concepts orally and in writing.
- and -
Demonstrated ability to effectively and confidently advise and interact with all levels of staff.

#SelectHealth

Physical Requirements:

Interact with others requiring the employee to communicate information.
- and -
Operate computers and other office equipment requiring the ability to move fingers and hands.
- and -
See and read computer monitors and documents.
- and -
Remain sitting or standing for long periods of time to perform work on a computer, telephone, or other equipment.

Location:

Vine Street Office Building

Work City:

Murray

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$23.70 - $37.32

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged.

Learn more about our comprehensive benefits packages for our Idaho, Nevada, and Utah based caregivers , and for our Colorado, Montana, and Kansas based caregivers our commitment to diversity, equity, and inclusion .

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.